On the Use of Engineers in Rehabilitation
COLIN A. McLAURIN, Sc.D.
Some 4,000,000 persons in the United States have some form of physical disability imposed by defect at birth, disease, or accident. These disabilities place limitations on vocational goals, personal independence, and even the very quality of the life the person can lead. The number cited does not include those millions who suffer from loss of sight or hearing.
About one-tenth of these disabled persons are amputees. Because of an extensive private artificial-limb service, and because of enlightened research and development projects that have been sponsored by the Veterans Administration and the Department of Health, Education, and Welfare for the past 25 years, nearly all amputees are assured not only of a good functional prosthesis but also of a good overall program in surgery and training as well. Unfortunately, the same kind of service is not usually available to the remaining 90 per cent of disabled persons. The reasons are clear. Since World War II, a continued and coordinated program of research, development, evaluation, and training has been funded by VA and HEW and other government agencies on behalf of the veteran and civilian amputee. In recent years, some of this effort has been directed toward bracing, but not to anywhere near the extent that is indicated by the scope of the problem.
Reasons other than those of funding have also been involved in the relatively slow progress made in this area. The most significant of these concerns the methods and environment whereby technical people can be effectively employed in developing appliances which will assist the disabled. From the limb program we have learned that engineers can make worthwhile contributions to rehabilitation, but only where there exists an effective method for delivery of services, and where the engineers in design and development work within that service or in close cooperation with it.
This type of close cooperation permits a common definition of the problem, an immediate observable source of test subjects for initial trials, and continued monitoring by all disciplines in subsequent redesigns and evaluations.
The facilities and staff for such programs have existed in some centres for many years, but the possibilities have been formally recognized only recently. In a recent report to the Social and Rehabilitation Service and the Veterans Administration, the Committee on Prosthetics Research and Development of the National Academy of Sciences has specifically recommended the establishment of several such centres throughout the country. The details of the recommendation are available. Briefly, it involves the employment of technical staff -engineers, prosthetists, orthotists, and technicians-capable of research, development, service and training activities in selected rehabilitation centres which have an active and representative case load. The name suggested for the type of work recommended is Rehabilitation Engineering, and the key principle is that the engineers work directly with patients on real problems, alongside their colleagues in the medical profession.
Obviously, some degree of special training is required for engineers working in such a program. Postgraduate training in biomedicine is certainly of value, but exposure to real patients and clinical problems on an internship basis is very strongly indicated. Many engineers may not be suitable for this type of work, and careful examination is essential in order to screen out the least effective persons as soon as possible. There appears to be no reason why engineers from aerospace or other areas could not be effectively employed in these endeavors. Indeed, they could be expected to bring to rehabilitation a wealth of special knowledge that is unavailable in academic training. It is most important, however, that such engineers be given a period of retraining or indoctrination in Rehabilitation Engineering prior to assuming any responsibilities for providing aid to the handicapped.
It appears evident that all major rehabilitation centres could profit from the effective employment of several suitably trained engineers. There is also good reason to believe that even the smaller centres could use at least one rehabilitation engineer. He could serve as a consultant in biomechanics and the alignment and function of limbs and braces; supervise the provision, adjustment, and maintenance of complex technical aids; and act as a contact between the centre and other centres doing similar or related work.
It is difficult to predict how many engineers could be effectively and economically employed in Rehabilitation. To date there is no method by which the cost effectiveness of such a program could be estimated. A recent study by the VA has shown that their expenditures of a little over $1,000,000 per year in research and development have not only resulted in better service to the amputee, but also in overall savings of $28,000,000 over a period of 25 years.
America is a country rich in engineering talent,"and technical achievements in the past few decades have been truly astounding. It remains to direct some of this talent, some of this technical progress to our 4,000,000 physically handicapped individuals. An overall saving in cost may or may not result, but there is little doubt that much can be contributed to the vocational potential and to the quality of life of these citizens.
Ontario Crippled Children's Centre Toronto, Ontario, Canada