Rehabilitation Science: An Emerging Field of Study

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Rehabilitation ScienceAn Emerging Field of Study

• Michelle Harris-Love
• January 2003

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Co-conspirators

• Enabling America Assessing the Role of
  Rehabilitation Science and Engineering (Brandt
  Pope, Eds., National Academy Press, 1997)

• Michael Harris-Love
• Sandy McCombe-Waller
• Beth Rasch
• Larry Forrester
• Etc., Etc.

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Whats that????
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Enabling America

• National Academy of Sciences (NAS)
• 1863 congressional charter to be adviser to U.S.
  federal government

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Enabling America

• National Academy of Sciences (NAS)
• 1863 congressional charter to be adviser to U.S.
  federal government
• Institute of Medicine (IOM)
• Chartered 1970 - enlist distinguished members of
  appropriate professions in examination of public
  health policy.

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Enabling America

• National Academy of Sciences (NAS)
• 1863 congressional charter to be adviser to U.S.
  federal government
• Institute of Medicine
• Chartered 1970 - enlist distinguished members of
  appropriate professions in examination of policy
  matters pertaining to public health.
• Committee on Assessing Rehabilitation Science and
  Engineering

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Committee on Assessing Rehabilitation Science and
Engineering

• Approved by Governing Board of National Research
  Council (NAS, National Academy of Engineering,
  IOM).
• Committee members chosen for special competences
  with regard for appropriate balance.
• Current federal research projects
• Informed opinions re needs, priorities,
  effectiveness of federal research programs
• Polled consumers
• Held focus groups w/ professional associations
• Interviewed federal agency officials

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Models of Disability and Rehabilitation

• Conceptual model
• Aids in
• Thinking about complex systems
• Understanding general relationships
• Generating new ideas

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Models of Disability and Rehabilitation

• Conceptual model
• Aids in
• Thinking about complex systems
• Understanding general relationships
• Generating new ideas
• A common understanding of terms such as injury,
  impairment, functional limitation, ... is
  essential to building effective, coherent
  programs in rehabilitation science and
  engineering. (IOM, 1997)

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Models of Disability

• Nagi model (Nagi 1976)
• Pathology (e.g. arthritis)
• Impairment (e.g. limited joint ROM)
• Functional limitation (e.g. inability to type)
• Disability (e.g. inability to work as a
  secretary)
• Other models
• WHO (International Classification of Impairments,
  Disabilities, and Handicaps, 2002)
• IOM (Disability in America, 1991)
• NCMRR (1993)

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Original IOM Model (1991)

• Focus on prevention
• ID risk factors to prevent disability
• Disability limitation in access
• Social opportunities (employment, education,
  parenthood, etc.)
• Physical space
• Implies disabling process is unidirectional
• No provision for reversal of disabling process
  (i.e. rehabilitation)

Pathology ? Impairment ? Functional Limitation ?
Disability
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New IOM Model (1997)

• The Person
• Rehabilitation enabling process
• Includes no disabling conditions
• The Environment
• 3-dimensional mat - supports interacts with the
  person
• Disability
• Product of interaction between person
  environment

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Conceptual Overview of Enabling-Disabling Process
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Conceptual Overview of Enabling-Disabling Process
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Conceptual Overview of Enabling-Disabling Process

• Rehabilitative process
• Expand access to environment
• Restore function in individual

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The Enabling-Disabling Process

• The Individual
• Bidirectional arrows
• Transitional factors

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The Enabling-Disabling Process

• The Individual
• Bidirectional arrows
• Transitional factors
• Risk Factors increase likelihood of moving
  left to right in model
• Enabling Factors increase likelihood of moving
  right to left

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The Person-Environment Interaction
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The Person-Environment Interaction
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The Person-Environment Interaction
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Disability Interaction Between Person and
Environment
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Disability is displacement of the environmental
mat

• Amount of displacement is function of
• Strength of physical and social environments
• Magnitude of potentially disabling condition.

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An impairment or functional limitation (i.e.
potential disability) will lead to greater
disability in a less supportive environment than
it would in a more supportive environment
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Represented Mathematically
P Pathology I Impairment FL Functional
Limitation PD Potential Disability E
Environment D Disability
P I FL PD
D PD / E
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Conceptual Parameters of Rehabilitation Science
and Engineering
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Rows Disability-related variables Columns
Performance measures
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Rows Disability-related variables Columns
Performance measures
Single cell in matrix constitutes minimum
requirement for research to be classified as
rehabilitation science
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Rows disability-related variables Columns
performance measures
Single cell in matrix constitutes the minimum
requirement for research to be classified as
rehabilitation science
A row variable studied across several performance
states, represents enabling-disabling process.
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Conceptual Parameters of Rehabilitation Science
and Engineering

• Useful for
• Identifying the focus of rehabilitation science

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Conceptual Parameters of Rehabilitation Science
and Engineering

• Useful for
• Identifying the focus of rehabilitation science
• Defining which research activities address
  rehabilitation

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Conceptual Parameters of Rehabilitation Science
and Engineering

• Useful for
• Identifying the focus of rehabilitation science
• Defining which research activities address
  rehabilitation
• Providing new possibilities for future research

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Every research study in rehabilitation science
must have some measure of disability-related
function (columns) and some measure of a
disability-related variable, either of the person
or of the environment (rows).
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Every research study in rehabilitation science
must have some measure of disability-related
function (columns) and some measure of a
disability-related variable, either of the person
or of the environment (rows).
It is not sufficient to study a classification
of illness or disease without a measure of
performance.
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The highest priority in rehabilitation science
and engineering is for studies yielding causal
explanations of disabling and rehabilitative
processes.
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The highest priority in rehabilitation science
and engineering is for studies yielding causal
explanations of disabling and rehabilitative
processes.

• Matrix reveals unique nature of rehabilitation
  science
• Emphasis on function

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The highest priority in rehabilitation science
and engineering is for studies yielding causal
explanations of disabling and rehabilitative
processes.

• Matrix reveals unique nature of rehabilitation
  science
• Emphasis on function
• Focus on factors that lead to transitions between
  pathology, impairments, functional limitation,
  disability

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The highest priority in rehabilitation science
and engineering is for studies yielding causal
explanations of disabling and rehabilitative
processes.

• Matrix reveals unique nature of rehabilitation
  science
• Emphasis on function
• Focus on factors that lead to transitions between
  pathology, impairments, functional limitation,
  disability
• Examine physical, behavioral, environmental,
  societal factors that influence these transitions

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The highest priority in rehabilitation science
and engineering is for studies yielding causal
explanations of disabling and rehabilitative
processes.
Matrix IDs combinations of variables which are
not likely studied in the separate, existing
basic science, health professional, and
engineering disciplines.
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Rehabilitation Science is multidisciplinary -
medicine, biomedical engineering, material
sciences, sociology, architecture, economics,
However, 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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Summary RS is unique in melding
multidisciplinary research knowledge into
conceptual matrix to address problems of people
with disabling conditions.
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Summary RS is unique in melding
multidisciplinary research knowledge into
conceptual matrix to address problems of people
with disabling conditions. RS combines variables
in ways that would not occur in the separate
existing sciences.
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Summary RS is unique in melding
multidisciplinary research knowledge into
conceptual matrix to address problems of people
with disabling conditions. RS combines variables
in ways that would not occur in the separate
existing sciences. RS organizes coordinates
research in existing disciplines to fill in
research gaps to ensure appropriate knowledge
base to address disability rehabilitation.
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Summary RS is unique in melding
multidisciplinary research knowledge into
conceptual matrix to address problems of people
with disabling conditions. RS combines variables
in ways that would not occur in the separate
existing sciences. RS organizes coordinates
research in existing disciplines to fill in
research gaps to ensure appropriate knowledge
base to address disability rehabilitation. High
est priorities for RS should be to, from the
rehabilitation perspective, focus, coordinate,
support currently fragmented research efforts.
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• Recommendations
• Committee recommends researchers educators
  adopt model presented.
• Programs supporting rehabilitation-related
  research should adopt terminology use as
  organizing tool.

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• Recommendations
• - Committee recommends researchers educators
  adopt model presented.
• Programs supporting rehabilitation-related
  research should adopt terminology use as an
  organizing tool.
• Multidisciplinary research teams needed to
  broaden scope of molecular-cellular organ-organ
  system research increase its relevance to RS.
  Additional funding recommended.

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Recommendations - Consensus panels should i.d.
areas of pathology impairment research in RS
that are high priority on basis of readiness of
knowledge to be translated to clinical care
potential impact on quality of life cost to
society.
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• Recommendations
• - Consensus panels should i.d. areas of pathology
  impairment research in RS that are high
  priority on basis of readiness of knowledge to be
  translated to clinical care potential impact on
  quality of life cost to society.
• NIH should ? number of peer reviewers who are
  rehabilitation scientists on all research review
  committees that consider grants in pathology
  impairment realms of RS.

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Conclusions
RS is emerging as organized, multidisciplinary
field of study makes unique contributions to
health, productivity, quality of life of people
with disabilities.
The field is ripe for major advances through
coordinated research efforts its broad
perspective of rehabilitation, engineering,
disabling conditions.
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Conclusions
RS will crosscut share, rather than subsume or
replace, research emphases in the existing health
engineering disciplines. RS will identify
address gaps in knowledge provide direction for
multi-perspective research unlikely to be
accomplished within separate, single-perspective
health engineering disciplines.
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The vision of rehabilitation science is that
better understanding of the causes factors
contributing to disability will lead to
better treatments technology for those with
disabling conditions. (Enabling America, 1997)