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Pages 393-404

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From page 393...
... administrative structure, 283-286 coordination and linkage activities, 287288 funding, 286, 287 information management division, 290291 organization, 287 rationale, 281, 292 recommendations for, 1-2, 21, 282-283, 296 research administration, 286 research divisions, 288-289 technology transfer role, 193-194, 199-200 training and career development division, 289-290
From page 394...
... 394 Agnosia, 141 American Academy of Physical Medicine and Rehabilitation, 333 American Congress of Rehabilitation Medicine, 333 American Physical Therapy Association, 333 American Speech-Language-Hearing Association, 333-334 Americans with Disabilities Act, 159-160, 167, 208 Animal companions, 86 Animal research, 10, 81, 83, 94, 98 Aphasia, 141 Apraxia, 141 Architectural and Transportation Barriers Compliance Board, 245, 353-354 Architectural design, 207-208 for hearing impairment, 135-136 toilet access, 125, 127 universal design, 151-152 Arthritic disorders, 115 Assessment and measurement, 63 burden-of-care measures, 103-104 cognitive functioning, 144 conceptual trends, 102 functional limitations, 101, 102-105, 108, 146 for hearing impairment, 133-134 hearing impairment as obstacle to, 136 individual differences in degree of disability, 79-80 of lifting limitations, 118, 119 of neuromuscular function, 93 outcomes research, 174-179 of speech limitation, 138, 140 terminology and taxonomy, 145, 378381 tools for, 85 whole person, 102-103, 105, 144, 146 Assistive technology, 150-151, 182, 213-214, 257 ADRR research, 289 education and certification, 237 Association of Academic Physiatrists, 333 Association of Rehabilitation Nurses, 334335 Ataxia, 103 Atrophy, 96 INDEX B Back pain, 11, 117 Balance, 109-111, 112 Barden-LaFollette Act, 34 Bending and lifting impairments, 117-119 Biological markers, 83 Biological sciences, 82, 83-84 Biomechanics, 92 Bladder control contextual disability, 124-125 disorders of, 122-123 functional limitations, 123-124 help-seeking behaviors, 123-124 quality of life issues, 124 research goals, 11 research needs, 126-127 secondary conditions related to, 125-126 Bowel control, 127-128 research goals, 11 Built environment, 150-152 Burden of care, 103-104 Bureau of Labor Statistics, 377 Bureau of the Census, 377 C Cartilage injury/repair, 91 Causes of cognitive impairment, 140-141 conceptual models, 63-64, 78-79 of disabilities, 2, 4346 of disability among children, 48-51 of dysphasia, 120-121 of functional limitation, 11 of limitations in activities of daily living, 47 of paralysis, 94-95 primary attributions, 46 of sexual dysfunction, 128 of speech limitations, 138 of visual impairment, 129-130, 131 of work limitations, 4647, 55 Centers for Disease Control and Prevention budget, 245, 266, 267 Disabilities Prevention Program, 266, 291-292, 358-360 education and training activities, 232233
From page 395...
... INDEX National Center for Injury Prevention and Control, 360-362 rehabilitation research, 14, 266-268 structure and function, 232, 266 Centers for Organization, Delivery, and Financing of Health and HealthRelated Services to People with Disabilities, 190 Cerebellar disorders, 110-111 Certification and credentialing assistive technology, 237 audiology and speech therapy, 239 occupational therapy, 239 orthotic and prosthetic professions, 239240 rehabilitation counseling, 237 rehabilitation engineers, 236 rehabilitation medicine, 235 rehabilitation nursing, 236-237 Children activity limitations, 4749 patterns of disability, 48-51 Chronic conditions, 51,181 Circulatory disorders, 46, 47 Clinical practice guidelines, 208-209, 216 Cochrane Collaboration, 202 Cognitive functioning causes of limitation, 140-141 coping patterns, 163-164 as mediator of disability experience, 161-162 memory, 142 research needs, 142-144 technical aids for problems of, 142 types of impairment, 141-142 See also Psychological factors Compensation programs, 159 Conceptual models, 3 basis for rehabilitation science and engineering, 75-78 development process, 62-63 historical evolution, 63-64, 78-79,147 person-environment interactions in, 7980, 147, 148 role of, 62, 65 unidirectionality, 67 See also Modified IOM model Consumer Assistive Technology Transfer Network, 213-214 Consumer perspective, 171-172, 182-183, 207-208 395 participatory action research, 210 private rehabilitation organizations, 342-346 research goals, 220 in technology transfer, 215 Control beliefs, 162 Coping, 163-164 Cost-benefit/cost-effectiveness analysis, 174-179, 190, 203-204 Cost of disability and rehabilitation, 1, 2, 18, 40, 57-58, 61, 273-274 advantages of early intervention, 55-56 benefits of functional improvement, 144-145 brain/spinal cord injury, 56-57 cost-effectiveness research, 174-176,178179 cost-of-illness methodology for estimating, 57-60 federal health care spending, 41 federal research spending, 14-15,18, 274-276 financing long-term support services, 183-184 goals of managed care, 184 health care reform efforts, 172 recommendations for research funding, 20-21 research needs, 12-13, 173 subacute care, 176 urinary incontinence, 123 work-related, 57, 58-59 Cultural factors, 73 definition, 154 as determinants of disability, 147-148 in disabling process, 155-157 help-seeking behaviors, 155-156 in intrapsychic processes, 157 social institutions, 157 See also Social environment; Socioeconomic factors Current Population Survey, 54-55, 59, 61 D Department of Agriculture, 193-194,195-196 Department of Defense, 272 Department of Education, 20-21, 283, 373, 375 See also National Institute for Disability and Rehabilitation Research
From page 396...
... See Socioeconomic factors Education and training, 38 accrediting and credentialing systems, 234-240 INDEX ADRR responsibilities, 289-290 assistive technology, 237 audiology and speech therapists, 240 clinical research, 203-204, 206-207 design of academic programs, 241-242 in governmental institutions, 226-234 implications of new conceptual model, knowledge sources, 224 mechanisms, 225-226 occupational therapy, 239 orthotic and prosthetic professions, 239 persons with disabilities, 231-232, 290 physical therapy, 238 primary care providers, 181 recommendations for, 190, 242-243 rehabilitation counseling, 237 rehabilitation engineers, 235-236 rehabilitation medicine, 235 rehabilitation nursing, 236-237 for research, 227, 228-231, 242-243, 253 Educational attainment, 55 Enabling factors, 71, 79 physical environment, 148-149 Enabling process conceptual models, 3, 6-8, 65-67, 220. See also Modified IOM model definition, 3, 24-25 economic system as factor in, 158-159 family factors, 165 goals, 3-5, 65 political system as factor in, 159-160 team approach, 26-27 Engineered environments ADRR research, 289 benefits of, 85 effectiveness, 152 research goals, 10 types of, 152 Engineering/physical sciences, 84-85 education of rehabilitation engineers, 236 Environmental factors, 1 built environment, 150-152 in cognitive functioning, 143-144 differences across settings, 79-80, 157 as enabling, 71, 79 in enabling-disabling process, 6-8, 11 12, 65-69, 71-73, 79-80, 148, 167, 169 hand/arm therapies, 115-116 improving functional capacity, 144-145
From page 397...
... INDEX intrapersonal, 73 in managing incontinence, 124-125, 127 mathematical modeling, 74-75 in measuring degree of disability, 79-80 in models of disability, 63-64 natural environment, 149-150 physical supports for human performance, 148-149 range of, 148 research needs, 78, 167-169 research trends, 165-166 treatment conceptualization, 27 see also Access to environment; Cultural factors; Social environment Epidemiology activity limitation, 42 among children, 47-51 brain/spinal cord injury, 56, 57 data collection needs, 60, 78 data sources, 41, 52-53, 54, 59, 377 demographic distribution, 42, 55 demographic trends, 12 disability with primary cause, 46 family patterns, 51-52 geographic distribution, 42 influences on research, 171-172 prevalence of disabling conditions, 2, 40, 42-43, 54, 60-61 recommendations for data collection, 61 severity of disabling conditions, 2, 40, 54 types of disabling conditions, 2, 43-46 urinary incontinence, 123 work limitations, 46-47, 54-55, 58 Equal Employment Opportunity Commission, 376 Exercise, 86 neuromuscular retraining, 110-111 strength training, 100, 108-109 F Families, 51-52 in enabling-disabling process, 165 quantity and quality of care, 183-184 Federal research adequacy of, 272-276 agencies and programs, 244-247, 295298, 352. see also specific agency or program consolidation of, 280-281 397 coordination of, 276-278 data sources, 377 effectiveness of, 38 evaluation of, methodology for, 327-330 opportunities to, 279-281 oversight, 246 spending, 14-15, 18, 244-245, 274-276 Focus group, 337-342 Food and Drug Administration, 191 Functional Capacity Index, 108 Functional limitations, 51 aging-related changes, 102, 104-105 assessment, 101, 102-105, 108, 146 bending and lifting, 117-119 bladder control, 122-127 bowel control, 127-128 causes of, 11 classification and terminology, 145 clinical taxonomy, 380 cognitive, 140-142 cross-cutting research issues, 102 cultural determinants, 155-157 definition, 5, 25, 101 dimensions of physical capacity, 108 in eating, 120-122 focus of rehabilitation, 101-102 hand/arm manipulation, 113-117 hearing, 132-136 impairment and, 100-102, 105 locomotor, 104, 108-113 mathematical modeling, 74-75 measurement, 100 recommendations for research, 145-146 research needs, 144-145 restoration goals, 3-5 scope of research, 10-11 secondary condition effects, 102, 104105 sexual, 128-129 speech, 137-140 strength training, 100, 108-109 visual, 129-132 G Gait analysis, 90, 93 functional limitation, 101, 103 research needs, 111-113 strength training effects, 109, 110 Gender differences, 42 General Services Administration, 375-376
From page 398...
... , 21, 41, 253, 256, 259-262, 277, 282 L Learning disability/mental retardation among children, 48 as main cause of impairment, 46 prevalence, 43 work limitations related to, 47 Lifestyle/behavioral factors, 6-8 Ligament injury/repair, 90-91 Locomotor function, 104, 108-113 Long-term care access issues, 182-183 delivery issues, 183-184 in managed care systems, 186
From page 399...
... See Engineered environments 399 Modified IOM model distinguishing features, 64, 67-69 enabling-disabling process in, 6-8, 65-71 historical evolution, 63-64 implications for policy, 80 implications for research, 79-80 implications for training, 80 macrosystems /mesosystems / Microsystems, 73, 159 mathematical modeling for, 74-75 person-environment interactions in, 7273, 148 psychological factors in, 73 rationale, 67 recommendations for, 80 representation of disability in, 69-70, 7374 representation of environment in, 69, 71-72 representation of individual in, 69, 70-71 risk factors, 71 transitional factors, 71 Molecular biology, 9-10, 82, 83-84 Mortality, as public health measure, 2, 24 Muscle repair, 10 historical technical development, 29 Musculoskeletal/tissue disorders, 43, 46, 47 among children, 48 atrophy, 96 clinical taxonomy, 378-379 current understanding and interventions, 87, 89-97 genetically associated, 83-84 healing processes, 90-91 neuromuscular system, 91-93 paralysis, 94-96 soft tissue injury, 90-91 synovial joints, 89-90 tissue grafts, 90-91 Myasthenia gravis, 94 N National Aeronautics and Space Administration, 374 National Cancer Institute, 196,199 National Center for Health Statistics, 377 National Center for Medical Rehabilitation Research, 14, 41 budget, 205, 244-245, 253, 362
From page 400...
... 400 education and training activities, 228-231 opportunities for improving, 291 organization and operations, 227-228 research activities, 228, 253-256, 362-363 structure and function, 251, 252-253 National Disability Statistics and Policy Forum, 60 National Health Interview Survey, 78 design, 41, 42 disability supplement data, 52-53 findings, 42-52 recommendations for, 61,190 National Institute for Disability and Rehabilitation Research (NIDRR) , 34 budget, 15,151, 244, 256-259, 355 education and training activities, 226-227 origins and development, 36 recommendations for, 1-2,16-18, 20-21, 282-283, 295-296 research activities, 14, 226, 256-261, 277 278, 355-356 strategies for improving, 279-280, 281 282 structure and function, 41, 151, 226, 256, 354-355 technology transfer activities, 195, 199, 212-214 National Institute on Deafness and Other Orthotics Communication Disorders, 374 National Institutes of Health clinical research funding, 205 disability-related research, 41, 246, 247 252, 276-277 recommendations for, 99,145,169 structure and function, 247 technology transfer activities, 199, 211 212 See also National Center for Medical Rehabilitation Research National Rehabilitation Information Center, 214, 356 National Science Foundation budget, 245, 268 education and training activities, 231-232 rehabilitation research, 14, 268-272, 372 373 structure and operations, 231, 268 Neurological disorders, 46, 47 among children, 48 bladder control, 122-123 clinical taxonomy, 379 INDEX hearing impairments related to, 133 neuromuscular injury and repair, 91-93 paralysis, 94-96 See also Spinal cord/brain injuries Neuroscience research, 10, 83, 87-89,143 Nursing, 219, 236 o Occupational therapy accreditation and certification, 239 historical development, 29, 34, 36 mission, 239 vocational rehabilitation, 36 Office of Disability, Aging, and Long-Term Care Policy, 245, 272, 363-365 Optimism, 164 Orthopedic disorders among children, 48 as main cause of impairment, 46 prevalence, 43 work limitations related to, 46-47 Orthopedic medicine historical development of rehabilitation science, 32 research needs, 113 certification for, 240 research needs, 113 role of, 239 Outcomes research, 203-204 attitude as outcome mediator, 164 on clinical investigations, 206-207 cost-benefit/cost-effectiveness analysis, 178-179 current inadequacy, 176-179 exercise intervention, 108-111 longitudinal studies, 178 need for, 174-176 quality of life measures, 176-177 use of comparison groups, 177 p Pacemakers, 92 Pain, 101 functional limitation assessment, 108 Paralysis causes, 94-95 effects, 94
From page 401...
... INDEX therapies, 95-96 work limitations related to, 47 Paralyzed Veterans of America, 335-336 Participatory action research, 210 Pathology among children, 48-51 benefits of research, 97-98 categories of activity limitations, 81-82 central nervous system dysfunction, 87 chronic conditions causing disability, 51 cultural factors in, 154-156 definition, 5, 25 disease markers, 83 economic factors in course of, 158 federal research efforts, 249 mathematical modeling, 74-75 preclinical studies, 81 prevalence of disabling conditions, 4346 research domains, 9-10, 81, 82-87 research needs, 97, 98 sexual dysfunction, 128 speech limitations, 138 visual impairment, 130, 131 Peer review process, 259 Personality factors, 164 Pharmacology research, 10, 84 technology transfer, 192 Physiatry, 30, 235 Physical therapy accredited programs, 238 historical development, 29, 30 practitioner supply, 238-239 professional activities, 30, 238 research for rehabilitation science, 86, 219 tissue healing processes, 90 Policymaking, 80, 159-160 consumer influence, 172 public health research for, 219-220 Polio, 30-31 President's Committee on Employment of Persons with Disabilities, 376 President's Committee on Mental Retardation, 376 Prevention, 67 home and recreational injuries, 360 primary care issues, 180-182 research for, 267-268 violence, 360, 361 Professional associations, 30, 34, 331-337 401 Professional development /standing, 37-38 academic programs for, 241-242 accrediting and credentialing systems, 234-240 ADRR activities, 289-290 implications of health care reform, 172 need for new discipline of rehabilitation science and engineering, 221-226, 294 opportunities for, 13-14 recommendations for, 18-19, 294 technology transfer mechanisms, 201203 Project ACTION, 369-370 Prosthetics, 10 certification for, 240 engineering advancements, 111 hand/arm, 116-117 historical development, 28, 29, 30-31, 32-34 neuromuscular system, 92 research areas, 85 role of, 239-240 utilization, 183 Psychological factors in back pain-related work limitation, 119 control beliefs, 162 coping patterns, 163-164 as environmental mediators of disability experience, 148, 160-161, 164-165 in models of enabling-disabling process, 73 personality disposition, 164 research needs, 165 self-efficacy beliefs, 161-162 social cognitive processes, 161 social-cultural influences on, 157 training of rehabilitation counselors, 237 See also Cognitive functioning Q Quality of life as measure of public health, 2, 24 as outcomes measure, 176-177 urinary incontinence and, 124
From page 402...
... 402 Race/ethnicity R prevalence of disabling conditions, 42, 51-52 prevalence of work disability, 55 Randomized controlled trials, 177, 201 Rehabilitation Act of 1973, 36 Rehabilitation counseling, 237 Rehabilitation engineering, 34, 236, 249, 253, 258, 269 ADRR research, 289 Rehabilitation medicine, 235 historical development, 28-36 See also Medical management/ treatment Rehabilitation Nurses Foundation, 334-335 Rehabilitation process. See Enabling process Rehabilitation science and engineering accrediting and credentialing systems, 234-240 conceptual matrix for, 75-78 contributions of, 14 definition and scope, 5, 13-14, 25, 75-78, 223-225 design of academic programs for, 241 242 general priorities, 1, 19 historical development, 27-36 integration of research disciplines, 219 221 need for new discipline of, 221-223, 225 226, 294 need for review of systems, 2-3, 36-38 paradigms of, 224-225 purpose, 224 research domains, 8-9, 13, 14 scientific disciplines in, 9-10, 82, 218 219,242 uniqueness of research project, 86-87 See also Education and training; Professional development / standing Rehabilitation team, 26-27, 28-29 Reproductive biology, 129 Research activities, 1 Research system clinical research, 203-207 conceptual matrix for rehabilitation science, 75-78 INDEX current organization and administration, 13-18, 38, 41, 272-278 data collection, 60, 61, 78 education and training, 227, 228-231, 242-243 funding, 296-298 historical development in U.S., 32-36 opportunities for improvement, 16 peer review process, 21, 99 policy decisions, 160 priorities, 19, 294-295 priority setting, 87, 99 public access to, 215, 216, 290-291 recommendations for, 19-21, 61, 98-99, 145-146, 167-169, 43, 296-298 team approach, 27 technology transfer process, 13 uniqueness of rehabilitation science and engineering, 86-87 See also Federal research; Technology transfer Research topics balance impairment, 109-111 biological sciences, 9-10, 82, 83-84 bladder control, 126-127 cognitive functioning, 142-144 disability, 11-12 domains of rehabilitation science and engineering, 8-9 eating limitations, 121-122 enabling factors, 79 engineering/physical sciences, 84-85 environmental factors, 165-169 functional limitation, 9-10, 102-105, 144146 hand/arm therapies, 116-117 hearing impairment, 136 human musculoskeletal systems, 87-97 lifting limitations, 118-119 locomotion, 111-113 measurement of disability, 79-80 outcomes, 174-179, 203-204 pathology and impairment, 9-10, 81, 8287, 97-98 pharmacological, 10, 84 public health, 219-220 randomized controlled trials, 177, 201 sexual functioning, 129 skeletal muscle, 93-97 social/behavioral sciences, 82, 85-86
From page 403...
... INDEX speech rehabilitation, 140 strength training mechanisms and outcomes, 108-109 translational, 203-204 visual impairment, 131-132 See also Health services research Respiratory disorders, 46 among children, 48 Risk adjustment/risk management, 187 Risk factors, 67 enabling factors and, 71 in modified IOM model, 71 Robotics, 92-93 S Sandia National Laboratories, 334 Secondary conditions, 205-206 in bladder impairment, 125-126 definition, 5, 25, 104 functional limitations assessment, 102, 104-105 prevention, 180 risk for persons with disability, 180 Self-efficacy beliefs, 161-162 Sensory stimulation as enabling factor, 149 See also Hearing impairment; Visual impairment Severity of disabling conditions educational attainment and, 55 environmental determinants, 73, 147148 epidemiology, 2, 40, 54 hearing impairment, 133-134 obstacles to measurement, 79-80 Sexual functioning, 128-129 Sign language, 132, 134 Smith-Fess Act, 34 Social/behavioral sciences, 82, 85-86 Social environment animal companionship, 86 cognitive impairment and, 143 components of, 154 economic system, 158-159 family functioning, 165 institutions of, 157 modified IOM model, 69, 72-74 participatory action research, 210 physical environment and, 148 political system, 159-160 403 societal limitations model, 64, 67 See also Cultural factors Social Security Administration, 245, 272 Socioeconomic factors, 54, 55, 158-159 among families with disabled members, 52 as determinant of disability, 73 Speech impairments assessment, 138 functional limitations, 137 research needs, 140 therapeutic interventions, 138-140 types of, 137-138, 139 Spinal cord/brain injuries benefits of early intervention, 55-56 cognitive impairment, 140-142 current understanding and interventions, 87-89 economic costs, 56-57 prevalence, 56, 57 research trends, 10, 11 Strength training, 100, 108-109 Stuttering, 139 Subacute care, 175-176 Surgical interventions attitude as outcome mediator, 164 hand/arm, 113-115 Survey of Income and Program Participation, 54, 61 T Taxonomy, 145, 378-381 Technology-Related Assistance for Individuals with Disabilities Act, 150-151 Technology transfer, 38 ADRR activities, 290-291 barriers, 200-201, 214 benefits, 200 clinical practice guidelines in, 208-209 clinical practice mechanisms, 201-203 clinical research for, 203-208, 216 definition, 13, 191 difficulty of, 191 federal mechanisms, 210-214 federal role, 198-200 funding, 201 goals, 191, 199-200, 214 implementation, 13 incentives, 207-208
From page 404...
... 404 legal environment, 195 market considerations, 198 models for, 193-194,195-196 obstacles to, 13 organizational structures for, 194-196 participatory action research, 210 promoters of, 196-198 recommendations, 214-216, 295 sources of technology, 194 unique needs of rehabilitation science, 192-193 Therapeutic process/technique bladder control interventions, 126-127 for cognitive impairment, 142-144 for disuse atrophy, 96 drooling interventions, 122 eating limitation interventions, 121-122 economic benefits of early intervention, 55-56 exercise intervention outcomes, 108-111 hand/arm interventions, 113-117 for hearing impairment, 134-135 historical development, 27-34 research for rehabilitation science, 82, 86 skeletal muscle paralysis, 95-96 for soft tissue injury, 90 for speech limitations, 138-140 for spinal cord/brain injuries, 87-89 for synovial joint rehabilitation, 90-91 team approach, 26-27 See also Medical management/ treatment Transitional factors, 71 cultural, 155-157 U United States Information Agency, 377 Universal design, 151-152 ADRR research, 289 INDEX V Veterinary science, 86 Visual impairment among children, 48 causes of, 129-130 certification of therapists for, 240 functional limitations, 129-131 as main cause of impairment, 46 prevalence, 43 research needs, 131-132 research trends, 11 technical aids for, 131 work limitations related to, 47 Vocational rehabilitation, 36. See also Occupational therapy W Wheeled locomotion, 113 toilet access, 125 universal design for, 150 Work limitations back pain, 119 bending and lifting impairments, 117118 bladder control, 124-125 community factors, 158 cost estimates, 57, 58-59 environmental determinants of disability, 73 epidemiology, 4647, 54-55 models of disability, 63-64 rehabilitation outcomes research, 178 research needs, 60 rights of job applicants and workers, 159-160


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