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

Edward N. Brandt, Jr.
Andrew M. Pope
Editors
Washington, D.C.
National Academy Press
1997, 404 pp.
Publisher's Price: $47.95 plus $4.00 for shipping and handling.

This book is comprised of a report prepared for the U.S. Congress by the Institute of Medicine. The report contains an assessment of the current knowledge base in rehabilitation science and engineering, an examination of the utility of various rehabilitation models, descriptions and recommendations pertaining to the dissemination and utilization of research findings, and an evaluation of federal rehabilitation science and engineering programmatic efforts. The conclusion drawn from these activities is that the examined federal research programs are lacking in visibility, funding, and coordination. Consistent with the charge by the Congress, recommendations for fixing the problems have been included.

Inasmuch as the report may serve as the basis for federal policy changes that affect what and how rehabilitation-related research is selected and carried out, it is important reading for all rehabilitation-related professionals, administrators, academicians, and policy makers, as well as persons with disabilities.

The content of the report was compiled by an ad hoc committee of eminent scientists, scholars, policy analysts, and others assembled by the Institute of Medicine. The Institute is a component of the National Academy of Sciences and has as its mission the advancement and dissemination of scientific knowledge to improve health. A major responsibility is to serve as an advisor to the federal government. The committee used a variety of approaches to gathering data that underpins the report, such as consumer polls, focus groups, interviews, and research reviews.

A strength of the report is that it does place and examine rehabilitation science and engineering within a systems framework. It was recognized that there are a multitude of intertwined social forces that have resulted in the current status and that will shape the future of these rehabilitation endeavors. The acknowledged professional domain, for example, includes rehabilitation medicine, engineering, nursing, assistive technology, counseling, physical therapy, occupational therapy, orthotics and prosthetics, and audiology and speech pathology. Moreover, in its presentation of an enabling-disabling process that determines disability, it emphasized the need for an array of research endeavors that attend to all system components, rather than limiting the focus to personal change issues. Even the seasoned rehabilitation veteran should find some grist for thought in this report.

To remedy the host of problems described in the report, the committee recommended that the National Institute on Disability and Rehabilitation Research be transferred from the U.S. Department of Education to the Department of Health and Human Welfare, where it would serve as the foundation for an agency on disability and rehabilitation research. The relocation was considered key to dealing with the identified visibility, efficiency, and funding problems. It was acknowledged that this recommendation would be controversial. One also must question how realistic the idea of creating a new agency is during a period in which spending reductions and government downsizing are in vogue. However, the potentially controversial recommendation is not a shortcoming of the book, but an inevitable outcome of recommending change. In fact, if the book only serves to gain attention to the problems, it will have been a worthwhile endeavor.

From my perspective, one the report's limitations is the short shrift given to psychiatric rehabilitation, habilitation of persons with mental retardation, and the contributions of special educators and their involvement in disability and rehabilitation research. The National Institutes of Mental Health, for instance, seems to have been left out of the equation. These are major disability population groups and players or potential players in the system. They are no less deserving of attention within the realm of rehabilitation science and engineering. It is puzzling as to why these forces do not appear to be represented on the IOM Committee. It can be argued that their presence could have had a substantial impact on the outcome.

Although the report stemmed from a congressional request to determine the state of affairs within the federal system, there did not appear to be a rationale for omitting non-federal rehabilitation scientific and engineering programming from consideration. If one is concerned with how many and in what way dollars are being spent on rehabilitation and disability research, one cannot disregard the millions or billions of dollars that are being spent by both not-for-profit and profit-making organizations in the private sector. If making the most effective use of limited dollars is a concern, public-private sector collaboration and cooperation seem just as important as that within and between agencies, and would seem to be a necessary part of the solution to related problems.

The report is illuminating. Because it may have far-reaching implications for the broad spectrum of rehabilitationists, it should be on the "must read" list. It will be interesting to watch this report's journey unfold.

Robert A. Chubon, Ph.D., CRC

University of South Carolina School of Medicine