Enabling America: Assessing the Role of Rehabilitation Science and Engineering.

Enabling America: Assessing the Role of Rehabilitation Science and Engineering

Brandt EN Jr, Pope AM, eds. Washington, DC 20055, National Academy Press, 1997, hardcover, 404 pp, illus, $47-95.

Disability and rehabilitation costs $300 billion annually in direct medical care expenditures and the lost productivity of 49 million Americans. By contrast, federal rehabilitation research is funded at only $133 million. Concerns regarding the state of rehabilitation science and engineering prompted the US Congress to request that the Institute of Medicine prepare the report that forms the basis of Enabling America. The interdisciplinary Committee on Assessing Rehabilitation Science and Engineering expanded this congressional mandate by evaluating the utility of current rehabilitation models, recommending ways to disseminate scientific findings in order to promote health and health care for people with disabilities, and evaluating current government programs pertaining to rehabilitation. The most far-reaching recommendation from the expert committee was that the National Institute on Disability and Rehabilitation Research be transferred from the US Department of Education to the US Department of Health and Human Services where it would serve as the foundation of a new Agency on Disability and Rehabilitation Research.

The committee's premise was that rehabilitation is an enabling process that aims at restoring function to the individual or expanding the person's access to the environment. The new model of the enabling-disability process shows transitional factors and quality-of-life interactions. Rather than viewing disability as a condition within the person, disability is viewed as the product of the interaction between the environment and the individual. The environment has both physical and psychosocial aspects, including discrimination, access to health-promoting activities, and transportation, which must be considered in modeling rehabilitation.

Ideas, products, and techniques that might foster rehabilitation do not always reach practical application because technology transfer is hampered by the lack of a well-organized mechanism for distributing research findings and by the paucity of relevant research. The committee stated that rehabilitation science and engineering is emerging as a multidisciplinary field of study. The goal of this field of study is to facilitate innovation, rather than to replace any constituent profession.

The committee formulated 3 overarching recommendations: (1) that rehabilitation science and engineering should be recognized as an academic and scientific field of study; (2) that the 3 most critical research priorities should be strengthening the science, focusing on the enabling-disability process, and transferring technology; and (3) that federal rehabilitation efforts can be enhanced by expanding research, increasing visibility, and improving coordination.

In addition to the committee's recommendations and rationale, this book provides an excellent compilation of epidemiologic statistics. The book also includes a list of acronyms; an executive summary; an extensive reference list; an index; and appendixes containing data collection and analysis, information sources on disability and rehabilitation research, taxonomy, and committee and staff biographies.

Physical therapists, regardless of practice site or clinical focus, are currently affected by the phenomena noted in this trenchant report. Health is no longer merely the absence of illness, reflected solely by mortality statistics. Rather, quality of life is of keen importance both to the public and to professionals. The physical therapy profession will be influenced greatly if the recommendations of the committee are adopted. The extent of government awareness about rehabilitation research should translate into public health initiatives that, in turn, will determine which disabling conditions have the highest research priority and which enabling modes are most generously supported. Enabling America: Assessing the Role, of Rehabilitation Science and Engineering is a lucid statement of profound concern to us as citizens and as health care professionals.

Joan E Edelstein, PT Columbia University New York, NY

Ms Edelstein is Associate Professor of Clinical Physical Therapy and Director, Program in Physical Therapy. She specializes in research and teaching of prosthetics, orthotics, and gait.