Dough: “IP834_C000” — 2006/11/8 — 11:41 — PAGE i — #1 Dough: “IP834_C000” — 2006/11/8 — 11:41 — PAGE ii — #2 Dough: “IP834_C000” — 2006/11/8 — 11:41 — PAGE iii — #3 Dough: “IP834_C000” — 2006/11/8 — 11:41 — PAGE iv — #4 Dedication This book is dedicated to the memory of Thomas J., a graduate of the University of Pittsburgh, Department of Rehabilitation Science and Technology. O’Connor was committed to studying technologies to expand com- munity participation and the quality of life of people with disabilities. As a person with a disability, he had addi- tional insight and understanding of the challenges faced. He was a scholar, a friend, and a colleague, who, due to his untimely death, never reached his full potential.
The editors and all of the authors have agreed to have their portion of the royalties from the sales of this book go to the Thomas J. O’Connor Fund at the University of Pittsburgh. These funds will support student involvement in rehabilitation engin- eering and assistive-technology-related education, research, and development to carry on Dr. Dough: “IP834_C000” — 2006/11/8 — 11:41 — PAGE v — #5 Dough: “IP834_C000” — 2006/11/8 — 11:41 — PAGE vi — #6 Foreword Rehabilitation Engineering is a nascent and developing field compared to most other engineering disciplines, yet there is compelling evidence that the practice of rehabil- itation engineering has its roots in antiquity.
Examples include use of a “stick” as an aid for ambulation, the attachment of wheels to a chair and many other implementa- tions to compensate for functional deficits. The utilization of a pole as a walking aid appears in an Egyptian stele in the Carlsberg Sculpture Museum (Copenhagen) that dates to 1500 BC. This same simple appliance may be observed in use in developing countries today. While prosthetics is often viewed as separate and distinct from rehab- ilitation engineering — perhaps most prominently by prosthetists — it is an obvious and natural subset of the larger concept of rehabilitation engineering.
Historically, warfare has provided a stimulus for advances in rehabilitation engin- eering, and it is not surprising to learn that medieval armorers as the first prosthetists were also the first rehabilitation engineers. The term “Rehabilitation Engineering” is of relatively recent vintage. Jim Reswick — a seminal contributor and pioneer for modern rehabilitation engineering — attributes this term to James Garrett, the Chief of Research and Development at SRS (Social and Rehabilitation Service), one of the principal early sources of support for rehabilitation engineering research and development (c. The modern era of rehabilitation engineering began with the establishment of “Rehabilitation Engineering Centers” (RECs) with support from the Federal Govern- ment through SRS in the early 1970s.
A program for “Rehabilitation Engineering Centers of Excellence” was proposed at a conference in Annapolis, Maryland, in 1970. These centers were defined in 1971 by an expert panel appointed by Elliott Richardson, Secretary of the U. Department of Health, Education and Welfare. The REC program was subsequently included in the Rehabilitation Act of 1973 — a “watershed” event for rehabilitation — and was mandated to receive 25% of agency (SRS) research funding (later reduced).
The REC program was initiated with the establishment of five centers at academic institutions with prominent engineering and medical engagement in rehabilitation. It is interesting to note that these original insti- tutions were selected to submit applications. These initial five RECs were awarded to Rancho Los Amigos Hospital, USC for FES of Nerves and Muscles; Moss Rehabilit- ation Hospital, Temple and Drexel Universities for Neuromuscular Control Systems; Texas Institute for Rehabilitation Research, Baylor and Texas A&M Universities for Effects of Pressure on Tissue; Harvard and MIT for Sensory Feedback Systems; and University of Virginia for Technology for People with Spinal Cord Injuries. Sub- stantial programs in rehabilitation engineering were also established by the Veterans Administration in selected VA Centers.
By 2000, the National Institute for Disability Dough: “IP834_C000” — 2006/11/8 — 11:41 — PAGE vii — #7 and Rehabilitation Research (NIDRR) was supporting 17 RERCs (Rehabilitation Engineering Research Centers). NIDRR was created, first as NIHR (National Insti- tute for Handicapped Research) in the newly founded U. Department of Education as the successor agency for research programs originally established in SRS. Research and development was the dominant focus for rehabilitation engineering during the decade of the 1970s and resulted in the formation of RESNA, the Rehab- ilitation Engineering Society of North America in 1980.
While R&D has continued as a major part of the rehabilitation field, an increased emphasis on the delivery of services began to emerge in the mid-1980s. By the mid 1990s service delivery had emerged as the major emphasis for both RESNA and for the field. Formal training programs in rehabilitation engineering and assistive technology were being offered at major universities. To date most of these training programs are attached to more traditional academic and professional training departments.
Those of us who have observed and contributed to the field of rehabilitation engin- eering over the past 20 to 30 years have seen extensive changes in both practices and in research and development. We have witnessed periods of rapid development resulting from federal and state support for research, service delivery and training. Rehabilit- ation engineering in many respects has been a creation of government, and while it is indisputable that government has been an advocate and benefactor for our field, it has also frequently been an adversary. Government has supported R&D for “orphan” technologies, and it has supported consumer advocacy.
But government has also lim- ited access to technologies and services., VA, Medicare, etc.) have frequently refused to support new, advanced technologies even when they have been proven to be more effective and provide for long-term functional and economic benefit. Disconnects between R&D agencies and support service agencies (SSA, CMS, etc.) have created interesting ironies, but they also have resulted in the formation of inter- esting alliances. We have responded by engaging in educational and informational efforts to inform policy, regulatory and legislative bodies. We have established and participated in the development of standards both to improve and guarantee qual- ity, and also to inform and assist government agencies with formulation of more enlightened policies for acquisition and approval.
The world of research and service for rehabilitation engineering and assistive tech- nology is an ever-changing landscape. We must be both vigilant and diligent if we are to continue to be viable as a profession and field of endeavor in the complex and often convoluted environment of healthcare and its sub-fields of rehabilitation and rehabilit- ation engineering. This must be a primary consideration in our education and training programs. If we are to do this well we must have reference and teaching materials that accurately reflect the state of our field.
An Introduction to Rehabilitation Engineering reflects the current state of art, science, engineering and technology for the fields of rehabilitation engineering and assistive technology. This book serves as both a refer- ence and a tutorial for our field. The fact that it is entitled as an Introduction suggests that it can be a starting point for those new to rehabilitation engineering. I would call your attention to the systematic presentation of objectives and corresponding present- ation of information in each section.
This book is also sufficiently comprehensive in coverage to serve as a reference to those with extensive of experience and accomplish- ments. The authors have taken care in providing explanations, and they make clear Dough: “IP834_C000” — 2006/11/8 — 11:41 — PAGE viii — #8 distinctions in definitions — for example, in distinguishing between rehabilitation engineering and the related field of assistive technology. The maturity and value of a field is proportional to its collected store of know- ledge and practices. These are in turn reflected by the literature of the field.
I trust that you will find this addition to our published knowledge to be an important and substantial contribution that will serve both those new to rehabilitation engineering and long-serving veteran clinicians and scientist-engineers. The editors and authors of An Introduction to Rehabilitation Engineering all have demonstrated their competence and expertise as clinicians, or engineers and scientists and in many instances in all of these domains. I feel privileged to know these dedicated and accomplished professional personally. It has been my pleasure and honor to review and comment on this important contribution to the field and discipline of rehabilitation engineering.
I commend this reference to you enthusiastically and with abiding satisfaction. Professor and Dean School of Health and Rehabilitation Sciences University of Pittsburgh Dough: “IP834_C000” — 2006/11/8 — 11:41 — PAGE ix — #9 Dough: “IP834_C000” — 2006/11/8 — 11:41 — PAGE x — #10 Preface This book was written as a collaborative effort by many of our friends and colleagues. It is intended to be used by advanced undergraduate students, graduate students, and interested professionals to introduce themselves to the exciting area of rehabilitation engineering and assistive technology. The book includes 18 chapters representing the major areas of research, development, and service delivery for rehabilitation engineers.
Each chapter provides a list of learning objectives and study questions to help guide the reader. At the end of the book, there is also a list of key terms and their definitions. We hope that this work will serve as a textbook in a university course and as a reference. The first chapter provides a brief introduction to rehabilitation engineering and assistive technology.
Included in Chapter 1 are key topics in the International Classific- ation of Function, design processes, and issues related to service delivery, research, and development. The participatory action design process is described because it provides a theme throughout the book. A new model, described as the PHAATE, is presented to incorporate the critical aspects of rehabilitation engineering and assistive technology. Clinical practice and application of rehabilitation engineering and assistive tech- nology are the ultimate goals.
Eventually, all of the models, devices, and policies are geared toward maximizing community participation through appropriate, if not optimal, service delivery. Chapter 2 covers the models for assistive technology service delivery, and briefly describes areas of practice and provides some guidance regarding good clinical practice. Credentialing is presented along with an explanation as to its importance. Assistive technology and rehabilitation engineering of devices for people with disabilities takes three basic approaches: design for use by the broadest possible pop- ulation, design for subpopulations, and design for the individual.
Chapter 3 describes helpful design tools and principles of universal design. An advantage of the universal design approach is that it helps to lower cost and increase access to products. How- ever, some individuals need customized products, and hence orphan technologies are also covered. For consumers to benefit from assistive devices; they have to be transferred to industry by some means or sufficient information has to be made available for clinical rehabilitation engineers to replicate the work.
Chapter 4 describes various technology-transfer mechanisms and models. Basic principles, such as consumer pull, are presented. Technology transfer is an area that has received substantial interest from the U. Federal government; hence, some of these mechanisms are described as well.
Dough: “IP834_C000” — 2006/11/8 — 11:41 — PAGE xi — #11 Quality assurance and the ability to objectively compare the properties of assist- ive devices are critical in the efforts to continuously improve products and services. National and international standards are important components of assuring and advan- cing quality of assistive devices. Chapter 5 describes the process for creating assistive device standards, and provides several examples of existing or proposed standards. While standards are important and necessary, they are not sufficient by themselves to ensure adequate quality and appropriate matching of the technology to the individual.
It is necessary to remain up to date with current scientific, engineering, and clinical literature and practices. The concept of the human body in a seated position seems simple, yet it is com- plex.