Accommodating specific job functions for people with hearing impairments.
The Americans with Disabilities Act (ADA) has galvanized action by requiring employers to make reasonable accommodations. The employment options for workers with disabilities are expanded when accommodation solutions facilitate performance of essential job functions. In recent years, there has been increased interest in competitive employment of people with disabilities. Parent and Everson (1986) discussed thirteen journal articles that examined disability and the workplace. The types of disabilities and occupations varied widely across the 13 articles, but the overall conclusions were consistent. The authors found low absenteeism, low accident rates, and low turnover rates for employees who have a disability. In addition, they found productivity, job performance, and employment costs to be on a par with employees who do not have a disability. The jobs represented in the study ranged from service occupations (e.g., housekeeping, food service worker) to clerical (e.g., data processor, file clerk) to technical fields (e.g., graphic arts, medical lab worker).
A worker with a disability may require a high-tech or low-tech accommodation in order to perform tasks that comprise a specific job. The accommodation should be directly related to an essential job function and lead to an increase in the productivity of the worker. A widely held belief of employers is that accommodations are expensive. A poll of 2,000 federal contractors, however, revealed that 81% of the accommodations made cost $500 or less (Pati & Morrison, 1982). In addition, responses from employers concerning the cost of workplace accommodations that were implemented were solicited by the Job Accommodation Network (Hendricks & Hirsh, 1991; Job Accommodation Network, 1987). As in the Pati and Morrison (1982) study, these responses revealed that most accommodations cost less than $500. Similarly, during the last quarter of 1994, staff of the Job Accommodation Network solicited and received 146 follow-up responses from employers. In 19% of these cases, the accommodation had no dollar cost, 49% cost less than $500, and 14% cost more than $2,000. Braille labels, modifications to telephone equipment, handrails, ramps, and adjusted work schedules are examples of inexpensive modifications that can improve worker productivity. Accommodations for a worker who has a hearing impairment might involve TT/TDD equipment, a telephone amplifier or headset, or meeting room amplification. These options are all relatively inexpensive and can result in increased worker productivity.
Accommodation and Hearing Impairment
People with hearing impairment are a heterogeneous population, representing the range of diversity found within the population as a whole. The complement of services provided to a particular individual, then, must reflect that individual's specific needs and not be based on diagnosis of hearing impairment alone (Danek, Seay, & Collier, 1989). The primary functional limitation of hearing impairment is usually considered to be a deficit in communicating. The vocational impact of hearing impairment tends to center around the issues of communication problems, education, inadequate vocational guidance, discrimination in employment, over-representation in lower-level jobs, attitudinal barriers in employment settings, and a lack of appropriate adaptive technology (Schildroth, Rawlings, & Allen, 1991).
Assistive communication and alerting devices are becoming more sophisticated and more affordable. No benefit accrues, however, when employers, people with disabilities, and service providers are unaware of these state-of-the-art devices (Leder, Spitzer, Richardson, & Murray, 1988). Leder, et al. (1988) interviewed 25 males who had profound hearing impairment and were about to undergo surgery for cochlear implants. Subjects were asked about their use of assistive technology. Only 11 of these 25 people used an assistive device(s). Some of those who did not use any assistive technology explained that (a) they did not know about the devices (n=4), (b) the devices were too costly (n=2), (c) family members hear for me (n=1), and (d) they had no one to call on an adapted phone (n=1). Those who used assistive devices reported that they were essential for safety (e.g., to alert police, fire, and health professionals), to keep them informed about news events and weather, and to stay in touch with family and friends. The authors of the study concluded that one responsibility of service providers to be aware of developments in assistive technology and to disseminate this information to those with hearing impairments.
Technology and changing societal attitudes encourage people with hearing impairments (and other people with a disability) to expand their career options. Communication devices, alerting devices, speech aids, and other assistive technologies can adapt an environment so that an individual can meet performance criteria. Dissemination of information about these devices, however, is slow. Methods of educating people about the options that are currently available must be developed and exploited.
Job Accommodation Network
One response to the problem of locating workplace accommodation information is the Job Accommodation Network (JAN) which is funded through the President's Committee on Employment of People with Disabilities. JAN is an international consulting resource on methods of implementing accommodation solutions in the workplace. JAN consultants assist employers in finding specific products and methods that will aid workers with disabilities to perform the essential job functions. Since 1984, JAN staff have completed thousands of cases that involved making a recommendation for an accommodation for a person with a hearing impairment.
The result of a call to JAN is a specific suggestion(s) for making a workplace accommodation(s). The process consists of (a) systematic description of the problem, (b) cooperative matching of the capabilities of the potential worker with the essential functions of the job, and (c) specific recommendations for accommodation(s). The volume of calls from private-sector industry is evidence of both the magnitude of the problem and of the competence of the JAN staff. During 1992, JAN received over 1,500 calls each month from employers, people who have a disability, and service providers. Employers and employees have access to information they need that is in a form they can use. This type of support has proven valuable to employers and individuals with disabilities (Job Accommodation Network, 1993).
Are people with hearing impairments applying for or engaged in a variety of jobs? Are the essential functions to be accommodated primarily related to communication issues? Are employers more concerned about accommodations for a new hire or when the accommodation would result in retention or promotion of a current employee? What specific accommodation suggestions are made for workers with hearing impairments? Further, what are the interrelationships among type of job, essential job function, the employee's career progression, and accommodation suggestions? This investigation was designed to answer these questions. Systematic description of the variables and their relationships to one another allows a more thorough view of workplace accommodations for people with hearing impairments.
The records for this investigation contain information provided by callers to the Job Accommodation Network (JAN) from May 1, 1992 through April 30, 1993. Only cases concerned with accommodations for people with hearing impairments were analyzed (n-392). The hearing impairment group is the largest disability sub-group within the JAN database, and most of the hearing-related cases were handled and recorded by the same consultant. The confidentiality of individual case records was respected in accord with American Psychological Association and West Virginia University guidelines.
The design included the variables of type of job (n=11), essential function (n=14), and career progression (n=6) to determine the relationships among these variables and the accommodation suggestion that was recommended to the caller. Thus, the intent was to generate one-way frequency tables as well as relevant two-way relationships to describe the patterns of job accommodations for people with hearing impairments.
The type of job reported by the caller was classified as Clerical, Professional/Technical, Craft, All Job Classes, Operative, Paraprofessional, Service, Labor, Manager/Administrator, Sales, or Other/Unknown. The job categories are an expanded version of the US Census categories. For example, census data include Clerical jobs within the Administrative category, but Clerical jobs were treated as a separate category for this study. The All Job Classes category included those accommodations that were for a variety of job types within a single business or agency. For example, a caller may have had concerns about accessibility during a training session that involved employees from many job categories.
The essential functions of a job, as defined in the Americans with Disabilities Act (1990), are "Those basic job duties that an employee must perform to satisfy the scope of a job." Determining which job functions are essential and whether those functions can be adapted or accommodated so that a particular individual with a disability can perform the job are ADA mandates.
There are three criteria that distinguish an essential function from a marginal one. First, the function is essential to the job if the position was created to perform that function. For example, making change is an essential function for a cashier since the job was created so that customers could make purchases. Second, the function is essential if it must be performed by a specific employee because the company has a limited number of employees. For example, the only employee available to load the delivery truck in a small florist shop is the driver of the truck. Therefore, loading the truck is an essential function of the truck driver's job. Third, a function is essential if special expertise is required to perform it. For example, an essential function for a job as an interpreter for the deaf is skill in American Sign Language.
Examination of the 392 cases revealed 14 essential functions to be accommodated. They were Respond to Emergency, Respond to Normal Sounds, Respond to Abnormal Sounds, Respond to Page, Respond to Vehicles, Communicate via Phone, Use 2-Way Radio, Communicate with Co-worker, Communicate with Customer, Participate in Meetings, Transcribe Tape, Take Vital Signs, Function in Noisy Environment, and Participate in Training. Communication was at issue in most of the essential functions. Workers needed accommodations in order to communicate over the phone or 2-way radio, talk with customers or coworkers, or participate during meetings or training events. Several essential functions concerned worker safety. For example, workers required accommodations so that they could respond to alarms, other vehicles, or abnormal sounds from equipment.
The career progression of the person with a hearing impairment was recorded as Job Retention, New Hire, Improvement, Training, Advancement, or Job Seeking. The Retention category generally included those individuals who were injured on the job or had a progressive hearing loss and were trying to maintain employment. The New Hire category included those cases where an employer is considering a person with a disability for a particular job. In Improvement cases, employment was not dependent on finding accommodation, but the worker's productivity or satisfaction would be improved if one could be found. Training cases were those for which an accommodation would permit the individual with a disability to take part in a job-related training program. In Advancement cases, the employee was being considered for a promotion. Job Seeking cases involved determining what accommodations may be needed before the individual approaches a potential employer.
The accommodation suggestions included the equipment/devices, schedule changes, or worksite modifications that were suggested to callers. The products and adaptations recommended as accommodations were categorized into 36 groups within six classes. The Signal class was composed of those products which allow a signal that is typically received in an auditory mode (e.g., bell, whistle, alarm) to be either seen or felt by an individual who has a hearing impairment. For example, paging devices are typically worn on the belt and signal the worker via a series of beeps, but pagers are available which vibrate to signal the worker. The Telephone and Amplification class of products included (a) TT/TDD equipment which allows callers to send visual rather than auditory messages over telephone lines, (b) FM loop systems which amplify the voices of people in a meeting room and transmit them to a headset worn by the worker with a hearing impairment, and (c) amplified stethoscopes for medical professionals. The Communication Aids class of products included open and closed captioning options for videotapes, use of sign language and interpreters, as well as communication boards. The Computer class of products included computer equipment purchases as well as modifications to existing computer equipment (e.g., SeeBeep - - which converts the beeping prompts generated by the computer into a particular screen flash). The Environmental class of products included soundproof baffles to reduce noise in the work area and moving the worker away from noise produced by equipment, customers, or other employees. Requests for assistance in introducing a new employee into the worksite or for rights information were classed as "Other."
Type of job, essential functions, career progression, and accommodation suggestions were used to describe the range of workplace accommodations for those with hearing impairments. It was anticipated that these variables would allow analysis of current workplace accommodations for people with hearing impairments.
The procedure included coding and generating a computer dataset from the text database used by the Job Accommodation Network staff. The type of job and career progression of the employee or potential employee were recorded by the staff member by selecting an option from a list. The information concerning the essential function(s) and the accommodation suggestion were recorded in prose form within the "notes" section of each case. The data on type of job and career progression were verified by referring to case information (e.g., the name of the business and the case notes). The essential functions and accommodation suggestion were obtained by reading the case notes. Prior to scoring the data for these cases, the two investigators worked together to develop the scoring protocol by scoring cases jointly. Each investigator was responsible for scoring one half of the remaining cases. Approximately five percent of the cases were re-scored to ensure consistency of recording.
Frequency counts for type of job, essential functions, career progression, and accommodation suggestions were generated. Tables were constructed to present the data. The nature of job accommodations and products required for the specific types of jobs, essential functions, and career progressions are described. In addition, relationships among the independent variables demonstrate interactions of variables such as career progression and job type.
Type of Job
The type of job, frequency, and percentage are listed in the first three columns of Table 1. Each frequency count represents one of the 392 cases in the population.
It is often noted that people with hearing impairment are underemployed and over-represented in unskilled labor jobs. These cases, however, yielded a large proportion of employees in "white collar" occupations. The largest single category was Professional/Technical (25%). The Clerical, Paraprofessional, and Manager/Administrator categories totaled 127 or 32% of the cases. The lower-end [TABULAR DATA FOR TABLE 1 OMITTED] jobs (Craft, Labor, Operative) made up less than 20%.
Analysis of the frequencies of type of job by essential function showed that specific essential functions were not uniquely associated with a specific type of job. Rather, each of the types of jobs (excluding All Job Classes and Other/Unknown) had at least six essential functions associated with it (mean=9.5). For example, people in Clerical occupations needed accommodations for nine essential functions (Communicate via Phone, n=80, Communicate with Co-workers, n=22, Communicate with Customer, n=18, Respond to Normal Sounds, n=15, Transcribe Tape, n=15, Respond to Emergency, n=12, Participate in Meetings, n=9, Participate in Training, n=8, Function in Noisy Environment, n=6).
The primary (most frequent) essential function associated with each type of job is presented in Table 1. For example, 21% of the essential function frequencies for the Professional/Technical type of jobs were Communicate via Phone concerns. As a second example, 25% of the frequencies for essential function for Service jobs required an accommodation for Communicate with Customer.
The primary career progression associated with each type of job (Table 1) demonstrated that, overall, employers were most concerned with Job Retention of a current employee or Improvement of the current job situation. For example, 48% of the frequencies of career progression for Labor cases were in the Job Retention category. As a second example, 55% of the frequencies for career progression in the Manager/Administrator cases were in the Improvement category of career progression.
The primary accommodation suggestion associated each type of job appears in Table 1. For example, 20% of the accommodation suggestion frequencies for Clerical cases involved Phone Amplifiers. As a second example, 16% of the accommodation suggestion frequencies for Craft job cases were for Vibrating Signal products.
The essential functions for the 392 cases totaled 521 since a job could include more than one essential function. In Table 2, the predominant essential functions are Communicate over the Phone and Communicate with Co-workers (total=38%). As may be expected, over half of the frequencies for essential functions involved communication. Callers sought information related to communication difficulties over the phone, via radio, face-to-face, in group meetings, and during training (total = 62%). Safety concerns of the employers were reflected in the Respond to Emergency, Respond to Normal Sounds, Respond to Vehicles, and Respond to Abnormal Sounds categories (total=24%).
In the remaining columns of Table 2, relationships of essential function to (a) type of job and (b) accommodation suggestion are described. The relationship between essential function and career progression is not included because of a lack of logical relationship. That is, essential functions were tied to the work to be done (type of job) rather than the employment status (career progression).
The primary (most frequent) type of job associated with each essential function is included in Table 2. For example, 50% of the type of job frequencies for the Respond to Vehicles essential function were from the Labor job type. As a second example, 30% of job type frequencies for the Communicate with Co-worker functions were for Professional/Technical jobs. While these were the primary types of jobs associated with the essential functions (Table 2), it is also important to note the dispersion of jobs across each essential function. Both Participate in Training and Communicate via Phone were associated with 10 of the 11 types of jobs.
[TABULAR DATA FOR TABLE 2 OMITTED]
The primary accommodation suggestion associated with each essential function is reported in Table 2. For example, as might be expected, 62% of the accommodation suggestion frequencies for the Take Vital Signs function involved Stethoscope Amplifier. As a second example, 15% of the accommodation suggestion frequencies for Function in Noisy Environment were Sound Proofing.
There were 390 cases that included data on career progression. As seen in Table 3, Job Retention, New Hires, and Job Improvement accounted for more than 90% of the cases. Nearly one-third of the cases represented New Hire or Job Seeking employment status. Less than 3%, however, involved the Advancement (promotion) of a current employee.
In the remaining column of Table 3, the relationship of career progression to type of job is described. The relationships of (a) career progression to essential function and (b) career progression to accommodation suggestion are omitted. Although these tables were computed, career progression is not linked in any meaningful way to either of these variables. For example, an accommodation suggestion (e.g., TT/TDD) is related directly to the functions of the job (e.g., Communicate with Customer, Communicate via Phone) but not to whether the employee is seeking a job or is in training.
The primary (most frequent) type of job associated with career progression may be seen in Table 3. For example, 33% of the type of job frequencies for Job Seeking were Clerical jobs. As a second example, 26% of the type of job frequencies for Job Retention cases involved Professional/Technical positions.
The frequencies for accommodation suggestions are listed in Table 4 by class and type of product. The 392 cases resulted in over 900 product or adaptation suggestions. Telephone and Amplification equipment were suggested in 33% of the cases. These options included TT/TDD equipment, meeting room amplification, and amplified telephone headsets. Visual and Tactile Signal devices, including visual fire alarms and vibrating pagers, represented 30% of the options. The Communication method recommendations (17%) included use of interpreters during meetings and use of paper and pencil to write messages. Computers and computer modifications represented about 10% of the products suggested. These included the use of "real-time" word processing as a system of open captioning during large meetings, application of computer voice input devices, and PC projection equipment. Environmental changes [TABULAR DATA FOR TABLE 4 OMITTED] represented 7% of the total and included carpeting and sound-absorbing baffles which reduce environmental noise and allow a worker to use residual hearing more effectively. The Telephone and Amplification class, Signals class, Communication methods class, and Computer class of products could all be considered to be accommodations for deficits in communication. Together, these groups of products represent over 80% of the types of accommodations suggested.
Table 3 Career Progressions Career Progression Freq % Primary Type of Job (%) Job Retention 133 34.1 Prof/Technical (26) New Hire 116 29.7 Prof/Technical (26) Improvement 108 27.7 Prof/Technical (24) Training 17 4.4 Other/Unknown (59) Advancement 10 2.6 Labor & Operative (30)(a) Job Seeking 6 1.5 Clerical (33) a The symbol & indicates that two primaries had the same percent.
In the remaining columns of Table 4, relationships of accommodation suggestions to (a) type of job and (b) essential function are listed. The relationship between accommodation suggestions and career progression is not included because the type of product suggested is unrelated to the career progression of the individual.
The primary (most frequent) type of job associated with each accommodation suggestion is detailed in Table 4. For example, 36% of the type of job frequencies for vibrating pager accommodation suggestion involved Labor jobs. As a second example, 67% of the job type frequencies for the radio headset accommodation suggestion involved Operative job cases.
The primary essential function associated with each accommodation suggestion is reported in Table 4. For example, 51% of the essential function frequencies for the meeting room amplifier suggestion involved Participate in Meetings. As a second example, 33% of the essential function frequencies for vibrating signal accommodation suggestions involved the Respond to Emergency function.
Summary of Results
Of the 11 types of jobs in the study, a quarter of the cases were for professional-technical jobs. The same essential function was often involved in several of the types of jobs. Communicate over the Phone and Communicate with Co-workers were the most frequent essential functions to be accommodated. The largest category of career progression was job retention (34%). A third of the accommodation suggestions were for amplification and telephone products. Relationships among these four variables were presented.
An evaluation of 392 cases from the Job Accommodation Network during the April 1992 to May 1993 time period was used to demonstrate the pattern of job accommodation needs for people who have hearing impairments. The impact of type of job, essential functions, career progressions, and accommodation suggestions was examined and described.
A surprising finding related to type of job was the percentage of higher-level jobs in the sample. The frequency counts for jobs revealed that more than half of the sample were employed in professional/technical, paraprofessional, managerial, and clerical job classes. Only 11% of the cases were employed in the service job class. The literature describes under-employment of those who have a hearing impairment as the norm with an over-representation in entry-level service jobs. These cases, however, reveal a different picture. The masons for this finding may include the self-selecting nature of the sample. Employers who expend the effort to contact the Job Accommodation Network to seek an accommodation solution (a) may be more aware that workers with hearing impairments can contribute in high-level jobs, (b) may be more willing to make the investment of time and effort demonstrated by the call in order to fill a high-level job, but not for a lower-level job, and/or (c) may be part of a trend toward a more inclusive employment environment. In addition, an exact diagnosis or measure of the hearing impairment was not obtained for these cases. It is possible that people with severe hearing impairments are under-represented in these 392 cases.
Related, but seemingly inconsistent with the previous result, was the finding that there were few accommodation cases that were in the advancement category of career progression. Most of the cases were for improvement of the present work situation, retention of a worker in the current job setting, or accommodation of a new employee. Thus, from these data, it seems that promotion of current workers who have a heating impairment is a rarity or that accommodation in cases of advancement is not necessary. It is unclear whether people with hearing impairments are facing the glass ceiling and are not in line for promotion or whether long-term employees already in a job progression have accommodation solutions in place. It is probable that an additional accommodation would not be needed to promote a worker whose job performance within that environment is satisfactory.
As would be expected, most of the functional difficulties were related to communication with co-workers and/or customers. Enhancing the volume and clarity of communication, whether face-to-face or via telephone calls, meetings, training sessions, or 2-way radio, were frequent problems to be resolved. Safety issues such as responding to emergency signals, approaching vehicles, and abnormal machine sounds were also high-frequency accommodation needs. It would follow, then, that the products most often suggested to resolve the needs expressed in these cases would also be related to communication and safety. This was the case. Accommodation solutions that directly address interpersonal communication and worker safety accounted for over 80% of the accommodation suggestions.
The 394 cases resulted in 984 accommodation suggestions. For example, a caller from a small dry-cleaning store wanted to hire a person with a severe hearing impairment. In this small shop, the worker's duties would have included both operating the dry-cleaning equipment and waiting on customers. The employer was concerned about the worker's safety in operating equipment, responding to the door buzzer from the back room, and communication with customers. In this case, accommodation suggestions might have included (a) the reality that there is no inherent danger to a person with a hearing impairment in operating such equipment, (b) a flashing light to signal door entry, and (c) paper/pencil as necessary to communicate with the customer. Thus, two suggestions were made in this scenario. In addition, a list of descriptions of various visual signals and their manufacturers would have been sent to the caller.
Even within a fairly narrow disability category such as hearing impairment, the number of products and suggestions for employment accommodations is substantial in number. The specific needs of the worker coupled with the essential functions of the job help to define the specific product/solution combination that will allow the individual to enter or maintain productive employment in that particular job. Anecdotally, it is common for employers to request accommodation product information that will allow them to accommodate any person with a disability. That is, they seek to obtain all the items that will make their company accessible. This mythical "accommodation closet" does not exist. It is a process of education for the employer to realize that there are thousands of types of products and even more manufacturers of such products and that accommodations must be carefully matched with the needs of the employee. Sensitive consultation between the employer and an accommodation expert is required to meet the needs of both the employer and employee.
Once the needs are identified, finding information on accommodation products can be tedious. Local information resources include the library, other consumers, and the network of human-service professionals. On a national scale, potential information resources include National Technical Institute for the Deaf's National Center on Employment, Research and Training Centers, Rehabilitation Engineering Centers, ADA Regional Disability and Business Technical Assistance Centers, the National Rehabilitation Information Center, ABLEDATA, the Clearinghouse on Disability Information, Job Accommodation Network, and the Project Enable electronic bulletin board system. In addition, a variety of disability information is available through the Internet (e.g., web pages). During such explorations, it is essential to focus on the job function.
The frequencies for type of job by essential function and type of job by accommodation suggestion indicate that the essential functions and products were found across job types. Four of the types of jobs (professional/technical, clerical, paraprofessional, and sales) had communicate over the phone as a primary essential function. In fact, every type of job had some accommodation need concerning phone use. It was typical that each of the essential functions was associated with at least half of the job types. Concomitantly, many products were associated with each essential function and, therefore, each type of job. There were clearer relationships among some of the jobs and functions, however. For example, half of the counts for respond to vehicles were from the labor job class, and half of the counts for respond to abnormal sounds were from the operative job class.
Taken together, the pattern of findings for this group of individuals with hearing impairments demonstrates employment in relatively high-level jobs for people who are either not in line for promotion or do not require additional accommodations as they move up the career ladder. The job functions of concern were communication and safety, regardless of the job. That is, talking on the phone and responding to an emergency figured in most job classes. Of the 36 types of products, about a third were related to amplifying sound/speech, and a third concerned substituting a visual signal for an auditory one. The types of products/solution recommendations were more clearly tied to the essential function of the job than were category of job or career progression. Thus, the crucial aspect of making a worksite accommodation is to clearly and specifically identify the job function to be performed. The specific product/solution recommendation, then, follows from the needs the individual has to interface with the essential function of the job. This triad of essential function, accommodation suggestion, and product/solution is more powerful in the accommodation process than the type of job to be performed or the career progression of the worker.
Rehabilitation professionals continually seek ways to assist their clients to succeed in the workplace. Rehabilitation workers and consumers who have a clear vision of the relationship between specific job duties and the products and procedures that can accommodate a worker in fulfilling those duties will likely have greater success in finding and maintaining employment. Additional research is needed to determine the long-term effectiveness and level of employer and employee satisfaction with job accommodations for people with disabilities, in general, and for those with hearing impairments, in particular.
This dissertation was supported, in part, by the National Institute on Disability and Rehabilitation Research through the West Virginia Rehabilitation Research and Training Center (West Virginia University and West Virginia Division of Rehabilitation Services). Appreciation is expressed to Tim Crowe, Anne Hirsh, Anne Nardi, Rogers McAvoy, Kent Parker, Ranjit Majumder, and Lori Britton.
Americans with Disabilities Act of 1990, Public Law 101-336.
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Leder, S., Spitzer, J, Richardson, F., and Murray, M. (1988). Sensory rehabilitation of the adventitiously deafened: Use of assistive communication and alerting devices. Volta Review, 90, 19-23.
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Denetta L. Dowler, West Virginia University, PO Box 6122, Morgantown, West Virginia 26506-6122.
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|Author:||Walls, Richard T.|
|Publication:||The Journal of Rehabilitation|
|Date:||Jul 1, 1996|
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