Enabling America Assessing the Role of Rehabilitation Science and Engineering (1997) / Chapter Skim
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4 PATHOLOGY AND IMPAIRMENT RESEARCH
4 PATHOLOGY AND IMPAIRMENT RESEARCH
Pages 81-99
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From page 81... ...
, research in the pathology and impairment realms of rehabilitation science and engineering includes studies of isolated cells, tissues, and organs derived from human or animal subjects. The performance variables of interest are measures of molecular, cellular, and organ or organ system function.
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From page 82... ...
Biology, engineering, and the physical, social, and behavioral sciences all contribute to rehabilitation science and engineering, in that those disciplines provide knowledge related to the altered cell and organ functions that may lead to disabling conditions. Rehabilitation science and engineering is unique in that it melds the knowledge from these otherwise distinct disciplines and creates a multidisciplinary structure that allows one to understand the nature of disability, that is, how potentially disabling conditions develop, progress, or reverse and the factors that mediate disabling or enabling processes.
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From page 83... ...
For example, current animal models that are important to rehabilitation research include models of neuropathic pain, spasticity, decubiti, infection, contractures, arthritic disorders, abnormal ossification, skeletal muscle atrophy, locomotor deficits, scoliosis, bladder and sphincter dyssynergia, thrombophlebitis, peripheral ischemia, burns, visuomotor deficits, postural instability and vestibular ataxia, posture-related autonomic dysfunction, endocrinological deficits, and immunological deficits. Tissue cultures are used to model apoptosis or skin healing.
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From page 84... ...
Basic pharmacological research focuses on the mechanisms of drug actions. Rehabilitation science and engineering critically needs knowledge of how pharmaceutical agents act on cells with existing pathology and on impaired organs so that agents useful in the management of potentially disabling conditions and the prevention of secondary conditions can be found.
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From page 85... ...
One of the contributions of engineering to rehabilitation science and engineering lies in creating altered, supportive environments (external or internal) for people with disabling conditions, because when engineering of the environment is maximized, the manifestations of pathologies and impairments as functional limitations and disabilities are minimized.
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From page 86... ...
The health professional disciplines are also important to rehabilitation science and engineering in that they translate theoretical knowledge in rehabilitation science and engineering into innovations in therapeutics and evaluate their effectiveness. Veterinary science may also contribute to the knowledge of enabling processes in rehabilitation science and engineering.
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From page 87... ...
STATE OF KNOWLEDGE FOR SELECTED MANOR CAUSES OF PATHOLOGY IN ADULTS Since orthopedic and musculoskeletal pathologies and impairments are those most frequently associated with the most prevalent adult activity limitations, the committee reviewed the state of knowledge in selected fields related to the control and function of the musculoskeletal system. The following sections address neural restoration and regeneration, synovial joints and soft tissue, the neuromuscular system, and skeletal muscle in terms of state of knowledge and potential for development as an area of pathology and impairment research in rehabilitation science and engineering.
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From page 88... ...
In 1991, the National Acute Spinal Cord Injury Study showed that high-dose corticosteroids given to individuals within 8 hours after they sustain a spinal cord injury significantly improve their neurological recovery (Bracken et al., 1990, 1992~. More than a dozen other therapies have been reported to be neuroprotective in people who have sustained acute spinal cord injuries (Nockels and Young, 1992~.
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From page 89... ...
Cheng, Cao, and Olsen (1996) recently used peripheral nerve bridges and a growth factor to produce functional regeneration in adult rats with fully transected spinal cords.
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From page 90... ...
Surgical treatment of soft tissue injury often requires a postoperative rehabilitation regimen of physical therapy and activity restrictions. These protocols are generally not based on scientific studies, and thus, considerable research is needed in the area of postoperative rehabilitation to define proper protocols.
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From page 91... ...
It is also well documented that proprioceptive responses in the soft tissues around the synovial joints are important to injury prevention and rehabilitation. Scientific studies in this area have gained momentum in recent years, and this concept must be extended to the postoperative or postinjury rehabilitation of the soft tissues of synovial joints.
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From page 92... ...
Throughout the world, thousands of investigators connected with fields such as biomechanical engineering, robotics, physical therapy, orthopedics, physical medicine and science, sports medicine, exercise science, limb prosthetics, orthotics, psychology, and behavioral science are working in the field of biomechanics. Some are beginning to pull together neuroscience and biomechanics, a union that is important to understanding the complete system.
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From page 93... ...
Skeletal Muscle Skeletal muscle is the largest tissue mass in the human body and as such, it plays a dominant role in metabolism, thermal regulation, and fluid and electrolyte balance in the human body, in addition to being the contractile tissue responsible for all voluntary movement. Skeletal muscle is also requisite for exercise and the beneficial physical and psychological effects of exercise conditioning.
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From page 94... ...
Paralysis Any disruption of motor neuron function, in the neuromuscular junction, or in the spread of the action potential of the muscle fiber will cause paralysis of that muscle fiber. This accounts for the skeletal muscle paralysis in individuals who have sustained spinal cord injury, in individuals with direct motor neuron or muscle trauma, or in individuals with the disease myasthenia gravis, in whom the receptors for the chemical that carries the signal from nerve to muscle in the neuromuscular junction (acetylcholine receptors)
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From page 95... ...
The motor neurons in turn will activate skeletal muscle fibers in their physically distributed motor unit. This is in contrast to direct electrical stimulation of skeletal muscle by an exogenous electrode, which activates the clumps of fibers closest to the electrode and which, as a nonphysiological stimulus, can cause hypercontracture damage and pain.
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From page 96... ...
The recovery of skeletal muscle from atrophy is an important aspect of recovery from spinal cord injury and other causes of paralysis or from bed rest with no inherent paralysis (i.e., individuals in a non-weight-bearing state)
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From page 97... ...
In summary, because of the importance of skeletal muscle tissue and function to human performance and well-being, research on the adaptability and usage requirements for maintaining adequate skeletal muscle strength and function is important to rehabilitation science and engineering. Research specifically related to maintenance or recovery of skeletal muscle function for individuals with activity limitations is important as the scientific basis of rehabilitation and the prevention of secondary conditions.
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From page 98... ...
Given the past impact of basic and applied research in science and engineering on the advances in physical medicine and rehabilitation and on outcomes for persons with disabling conditions, the committee was surprised that the review of abstracts from the major federal funding agencies of research did not reflect an inclusion of this type of research in the portfolio identified as rehabilitation related. Only the VA portfolio reflected research utilizing animals and tissue culture subjects/cells and a balance of research activity across the research realms (pathology, impairment, functional limitations, disability)
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From page 99... ...
PATHOLOGY AND IMPAIRMENT RESEARCH 99 Recommendation 4.2 Based on the National Institutes of Health model, consensus panels should be used to identify areas of pathology and impairment research in rehabilitation science and engineering that are of high priority on the basis of the readiness of the knowledge of the basic science in these areas to be translated to clinical care and potential impact on quality of life and cost to society. Recommendation 4.3 National Institutes of Health should increase the number of peer reviewers who are rehabilitation scientists on all research review committees that consider grants in the pathology and impairment realms of rehabilitation science and engineering.
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