Overview

The patient has a spastic equinovarus foot overpowering the AFO, a shoulder that fires pain with every wheelchair push, and an electrodiagnostic study that needs to answer three questions before the surgeon will operate. When the wrong AFO gets prescribed, the wrong injection hits the wrong target, or the wrong exercise pushes a long COVID patient into a crash that lasts two weeks - the physiatrist made a decision at a fork they did not recognize. This handbook builds the clinical reasoning that identifies every fork, names the pathways, and anchors each decision to the single variable that resolves it. Inside this book: - The Physiatric Decision Pathway System - 45+ clinical forks with decision anchors and trap warnings across every chapter, consolidated in a dedicated back-of-book atlas for point-of-care reference - Axonal versus demyelinating in three variables - NCS pattern recognition that changes the differential and the prognosis in the same encounter - Tardieu before every injection - the one assessment that separates treatable spasticity from contracture no amount of botulinum toxin will fix - ESI approach by anatomy, not habit - transforaminal, interlaminar, or caudal matched to the lesion, the laterality, and the surgical history - Mirels score before every cancer rehab prescription - the fracture risk screen that prevents the catastrophic pathological fracture nobody anticipated - AFO biomechanics in five degrees - how ankle angle shifts the ground reaction force vector and produces recurvatum, crouch gait, or stable stance - Post-exertional malaise as the bright line - the long COVID fork separating graded exercise from activity pacing that prevents iatrogenic crashes Written for PM&R residents, fellows, practicing physiatrists, and rehabilitation professionals who make the decisions that determine whether patients walk, work, and live independently. Stop reading about rehabilitation. Start reasoning through it.

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