In response to this request, the Institute of Medicine assembled this committee to address the following questions:

  • What is the current content, quality, and adequacy of the knowledge base in rehabilitation science and engineering?
  • How useful are current disability models, and do they reflect the interdisciplinary and multidisciplinary nature of rehabilitation and the importance of environmental factors in mediating disability?
  • What is the best way to effectively translate scientific findings into clinical benefits for people with disabilities and disabling conditions?
  • How productive, relevant, and well-coordinated are current federal research efforts in rehabilitation science and engineering?

Following a brief description of concepts and definitions, the remainder of this summary presents an overview of the committee's responses to these questions and a summary of the committee's conclusions and recommendations.

Concepts, Definitions, and Models

Rehabilitation is the process by which physical, sensory, or mental capacities are restored or developed. This is achieved not only through functional change in the person, such as strengthening injured limbs, but also through changes in the physical and social environments, such as making buildings accessible to wheelchairs. Rehabilitation strives to reverse what has been called the disabling process, and may therefore be called the enabling process.

An overview of the enabling and disabling processes, and how disabling conditions affect a person's access to the environment is shown in Figure 1. Access to the environment, depicted as a square, represents both physical space and social structures (family, community, society). The person's degree of physical access to and social integration into the generalized environment is shown as degree of overlap of the symbolic person and the environmental square. A person who does not manifest disability (Figure la) is fully integrated into society and has full access to both: (1) social opportunities (e.g., employment, education, parenthood, leadership roles) and (2) physical space (e.g., housing, workplaces, transportation). A person with disabling conditions has increased needs (shown as the increased size of the individual) and is dislocated from their prior integration into the environment (Figure l b).

The enabling (or rehabilitative) process attempts to rectify this displacement, either by restoring function in the individual (Figure 1c) or by expanding access to the environment (Figure 1d) (e.g., building ramps).

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