Enabling America Assessing the Role of Rehabilitation Science and Engineering (1997) / Chapter Skim
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3 MODELS OF DISABILITY AND REHABILITATION
3 MODELS OF DISABILITY AND REHABILITATION
Pages 62-80
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From page 62... ...
In this way they are like an out-of-focus picture that partially reveals relationships. It is common in science and engineering to use models to help develop hypotheses that can be examined experimentally, but even as models assist scientists in moving forward with new understanding, they are abandoned for new versions.
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From page 63... ...
Thus, the American Medical Association's Committee on Medical Rating of Physical Impairments stated that "competent evaluation of permanent impairment requires adequate and complete medical examination, accurate objective measure of function, and avoidance of subjective impressions and nonmedical factors such as the patient's age, sex and occupation" (American Medical Association, Committee on Medical Rating of Physical Impairment, 1958~.
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From page 64... ...
was derived directly from Nagi, defining disability as "a function of the interaction of the person with the environment" and beginning to describe certain subsets of environmental factors that could potentially affect the development of and movement within a disabling process. In this model, physical and social environmental risk factors (as well as biological and lifestyle risk factors)
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From page 65... ...
The lack of a uniformly accepted conceptual foundation is an obstacle to research and to other elements critical to rehabilitation science and engineering. Using the definitions laid out in Chapter 1, this committee presents a new set of models, based primarily on the previous IOM model (1991)
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From page 67... ...
A second apparent shortcoming in the 1991 IOM model is its limited characterization of the environment and the interaction of the individual with the environment. Although the importance of the environment is discussed in the text in some detail, it is not clearly represented in the model except as a category of risk factors involved in the transition between the various categories of the disabling process.
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From page 68... ...
The Disability in America model (Institute of Medicine, 1991) is revised to include bidirectional arrows and a state of "no disabling condition," and to show transitional factors and quality of life interacting as part of the enabling-disabling process.
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From page 69... ...
To accomplish this diagrammatically, the new model is three-dimensional and has the following new features: 1. The person: Arrows pointing left were added to represent the potential effects of rehabilitation and the "enabling process" (risk factors and enabling factors are now combined into "transitional factorship In addition, the new model includes the designation "no disabling conditions" to indicate that there is a beginning and an end to the disabling process when a pathology, impairment, functional limitation, or disability does not exist.
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From page 70... ...
Physica/Environment \ ENABLING AMERICA Disability is a function of the interaction between the person and the environment THE "PERSON" (with potentially disabling conditions) Physical Environment ~' Social Environment DISABILITY I __.
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From page 71... ...
Weaker mats equate with nonsupportive environments. For example, physical barriers, discrimination, lack of accessible and affordable assistive technology, and lack of appropriate health care result in greater displacement of the mat and, therefore, cause greater disability.
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From page 72... ...
Examples of the types of things that might be included in each category include: Psychological and Social Environments · Discrimination · Access to health and medical care · Appropriate care · Access to technology · Culture · Employment · Family · Economy · Community organizations · Access to social services · Traits and personality factors · Attitudes and emotional states · Access to fitness and health-promoting activities · Education · Spirituality · Independence Physical Environments · Architecture · Transportation · Climate · Appropriate technology · Geography · Time Each of the items listed in the social and physical environments could be thought of as layers in the mat; for example, access to assistive technology would be a layer in the environment mat, and so if an individual had good access to assistive technology, a strong layer for assistive technology would be added to the mat. If there were no access to assistive technology, then this layer would be missing from the mat, thus weakening the overall support and increasing the resultant disability.
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From page 73... ...
For example, research on disability in the work setting indicates that the economic status of the overall labor market has a far greater impact on the employment status of people with disabling conditions than the willingness of individual employers to provide accommodations or the extent of the physical or mental impairment for that matter, even though both accommodations and extent of impairment do have some effect (Yelin, 1992~. Similarly, the overall culture frequently determines whether a limitation will be considered disabling.
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From page 74... ...
, and functional limitation (FL) , the first assumption is that the sum of these variables represents a quantity known as an individual's potential disability, or PD: P + I + FL = PD.
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From page 75... ...
CONCEPTUAL MATRIX FOR REHABILITATION RESEARCH The conceptual models presented here could form the basis for a new science rehabilitation science and engineering that embodies the underlying, rudimentary paradigm implicit in each. The committee believes that there is a legitimate and distinct field of study that justifies the term "rehabilitation science." Rehabilitation science emphasizes function, focusing on the processes by which disability develops and the factors in
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From page 76... ...
Third, rehabilitation science examines physical, behavioral, environmental, and societal factors that influence these transitions. Although rehabilitation science is multidisciplinary and utilizes methods from many fields including medicine, biomedical engineering, material sciences, sociology, architecture, and even economics, it is distinct from other scientific disciplines due to its emphasis on function, factors, and interventions that disable or enable people.
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From page 77... ...
Functional Pathology Impairment Limitation Disability Enabling Processes Personal and < - Environmental Disabling Processes Variables - > Personal (e.g., biology, behavior, resources) Natural processes (growth, maturation, development, aging, repair)
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From page 78... ...
In addition, some episodic surveys such as the Longitudinal Study on Aging and Health and Retirement Survey collect some information on accommodations provided by government, family, and employers. However, no ongoing surveys routinely collect information on the experiential and resource domains within personal factors and none collect information on such external environmental factors as the natural and engineered environment, access to rehabilitation specific therapies and health care, the availability of social supports, and the experience of the laws and regulations governing disability policy.
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From page 79... ...
(1995~. The committee strongly recommends that more research be done which emphasizes the effects of enabling environments on the lives of people with impairments and functional limitations.
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From page 80... ...
Recommendation 3.2 Based on the model of the enabling-disabling process described in this report, methods for quantifying disability should be developed that are sensitive to the characteristics of both the person and the environment. Such a metric wouldfacilitate additional research into the factors that affect transitions between disability and other states of the enabling-disabling process, and the development of effective preventive and rehabilitative intervention strategies.
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