Enabling America Assessing the Role of Rehabilitation Science and Engineering (1997) / Chapter Skim
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EXECUTIVE SUMMARY
EXECUTIVE SUMMARY
Pages 1-23
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associated with disability and rehabilitation are in stark contrast to the relatively small amount of funding ($133 millionJ that supports the major federal programs of research in rehabilitation science and engineering. To address these concerns, the report recommends that the National Institute on Disability and Rehabilitation Research program be relocated from the U.S.
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About another third are restricted in their major activities, and the remaining third are limited in other types of activities. In 1992, about one quarter of all disabling conditions stemmed from impairments such as sensory impairments, paralysis, or mental retardation, and the remaining three quarters were due to diseases or disorders such as emphysema, heart disease, or arthritis.
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· What is the best way to effectively translate scientific findings into clinical benefits for people with disabilities and disabling conditions? · How productive, relevant, and well-coordinated are current federal research efforts in rehabilitation science and engineering?
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What is unique about rehabilitation science and engineering is the melding of knowledge from several disciplines to understand the fundamental nature of the enablingdisabling processes, that is, how disabling conditions develop, progress, and reverse, and how biological, behavioral, and environmental factors can affect these transitions. Disability Models As originally described by Saad Nagi in the 1950s and refined most recently in the 1991 IOM report Disability in America, the disabling process has four major components: pathology, impairment, functional limitation, and disability (see Table 1~.
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The en hancements include bidirectional arrows between the various states of the enabling-disabling process to indicate that the disabling process (described in the 1991 IOM model) can be reversed with proper interventions (i.e., the enabling process; see Figure 2~.
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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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The interaction of the person and the "environmental mat" is depicted as a deflection in the mat. includes a new category no disabling conditions to indicate that complete rehabilitation is feasible.
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Physica/Environment \ DISABILITY, _ _ . 9 Disability is a function of the interaction between the person and the environment THE "PERSON" (with potentially disabling conditions)
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Research in the development of prosthetics and orthotics, implantable lenses and pacemakers, and implantable drug delivery systems are some examples of engineered devices that reduce or eliminate impairment and improve function. Recent findings in neuroscience and medicine hold promise for helping prevent and reverse neurological impairments, which are major causes of disabling conditions.
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This may lead to the development of visual training programs, behavioral strategies, and environmental adaptations that can contribute to the optimal functioning of individuals with such disabling conditions. Science and engineering has developed low-vision aids, text-to-speech reading machines, advanced mobility and guidance aids, and other assistive devices for those with vision loss.
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However, to the extent that health services research has included disability and rehabilitation in its agenda, it has focused primarily on issues regarding the care of children and elderly people; few studies have focused on the needs of working-age adults. Yet the number of workingage adults is growing faster than any other segment of the Copulation of people with disabling conditions.
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REHABILITATION SCIENCE AND ENGINEERING AS A FIELD OF STUDY Rehabilitation science and engineering, defined in this report as encompassing basic and applied aspects of the health sciences, social sciences, and engineering as they relate to restoring human functional capacity and improving a person's interactions with the surrounding environment, is beginning to emerge as an organized, multidisciplinary field of study. Three observations led to this conclusion.
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With academic and scientific structure, rehabilitation science and engineering will provide a focus for multidisciplinary research and generate a common knowledge base for individuals working in a rehabilitation team. ORGANIZATION AND ADMINISTRATION For the purpose of assessing the combined adequacy of federal efforts in addressing the health needs of people with disabling conditions, the committee reviewed the five major federal programs that focus on rehabilitation-related research and the overall organization and administration of these programs.
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National Center for Medical Rehabilitation Research (NCMRR) Centers for Disease Control and Prevention (CDC)
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In assessing a constellation of programs of this size and complexity, with the overall mission of addressing health needs of such magnitude, it is not surprising to find some apparent problems. Foremost among these are the need for improved coordination among the various and numerous federal research programs and the need for additional research in rehabilitation science and engineering that will help to improve the health, quality of life, and productivity of the millions of Americans with disabling conditions.
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Not related: Projects that do not clearly address any rehabilitation state. bNo disabling conditions: Research that addresses the state of function or use of subjects with no disabling conditions to investigate mechanisms that are potentially relevant to assessing and treating disabling conditions.
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. Most importantly, however, significant savings in health care costs, lost wages, and reduced emotional costs could be realized by enhancing research in rehabilitation science and engineering and improving the health, productivity, and quality of life of people with disabling conditions.
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Thus, the committee's second overarching recommendation is as follows: Overarching Recommendation 2. As the field of rehabilitation science and engineering continues to evolve and gain recognition as an academic and scientific field of study, three general priorities will and should be offundamental importance to its growth and to the ultimate improvement of health, productivity, and quality of fife for people with disabling conditions: strengthen the science,focus on the enabling-disabling process, and transfer the technology.
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As the largest federal program with a focus on disability and rehabilitation-related research, NIDRR's program was of major interest to the committee. The NIDRR mission and its constituency of people with disabling conditions are fundamentally important to the research agenda of rehabilitation science and engineering espoused by this committee.
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Secondly, it would move NIDRR closer administratively to NIH and CDC, which should facilitate coordination among the agencies. Finally, it would allow improvements in the peer review process, including larger, more permanent peer review panels that could be formed to allow for the review of a more heterogeneous mix of applications, and broader representation (including people with disabling conditions)
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