Index

A

ABLEDATA, 214

Access to care, 71, 179

long-term support services, 182-183

managed care and, 185

primary care, 180-182

recommended research, 190

Access to environment, 149

assistive technology for, 150-151

definition, 3

engineered environments research, 10

goals of enabling process, 3-5

universal design for, 151-152

Accredited programs

occupational therapy, 239

physical therapy, 238

rehabilitation counseling, 237

rehabilitation medicine, 235

rehabilitation nursing, 236

Activities of daily living

causes of limitations in, 47

functional limitations assessment, 103-104

locomotor assessment, 103

long-term support services, 182

prevalence of disabling conditions, 42

Activity limitation

categories of, 81-82

definition, 42

prevalence, 42-43

Acute care, 173, 179, 196

Administration on Developmental Disabilities, 374

ADRR. See Agency on Disability and Rehabilitation Research

Advisory panels, 375-376

Age-related change, 104-105

research needs, 146, 171

Agency for Health Care Policy and Research, 357-358

Agency on Disability and Rehabilitation Research (ADRR)

administrative structure, 283-286

coordination and linkage activities, 287-288

funding, 286, 287

information management division, 290-291

organization, 287

rationale, 281, 292

recommendations for, 1-2, 21, 282-283, 296

research administration, 286

research divisions, 288-289

technology transfer role, 193-194, 199-200

training and career development division, 289-290



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--> Index A ABLEDATA, 214 Access to care, 71, 179 long-term support services, 182-183 managed care and, 185 primary care, 180-182 recommended research, 190 Access to environment, 149 assistive technology for, 150-151 definition, 3 engineered environments research, 10 goals of enabling process, 3-5 universal design for, 151-152 Accredited programs occupational therapy, 239 physical therapy, 238 rehabilitation counseling, 237 rehabilitation medicine, 235 rehabilitation nursing, 236 Activities of daily living causes of limitations in, 47 functional limitations assessment, 103-104 locomotor assessment, 103 long-term support services, 182 prevalence of disabling conditions, 42 Activity limitation categories of, 81-82 definition, 42 prevalence, 42-43 Acute care, 173, 179, 196 Administration on Developmental Disabilities, 374 ADRR. See Agency on Disability and Rehabilitation Research Advisory panels, 375-376 Age-related change, 104-105 research needs, 146, 171 Agency for Health Care Policy and Research, 357-358 Agency on Disability and Rehabilitation Research (ADRR) administrative structure, 283-286 coordination and linkage activities, 287-288 funding, 286, 287 information management division, 290-291 organization, 287 rationale, 281, 292 recommendations for, 1-2, 21, 282-283, 296 research administration, 286 research divisions, 288-289 technology transfer role, 193-194, 199-200 training and career development division, 289-290

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--> Agnosia, 141 American Academy of Physical Medicine and Rehabilitation, 333 American Congress of Rehabilitation Medicine, 333 American Physical Therapy Association, 333 American Speech-Language-Hearing Association, 333-334 Americans with Disabilities Act, 159-160, 167, 208 Animal companions, 86 Animal research, 10, 81, 83, 94, 98 Aphasia, 141 Apraxia, 141 Architectural and Transportation Barriers Compliance Board, 245, 353-354 Architectural design, 207-208 for hearing impairment, 135-136 toilet access, 125, 127 universal design, 151-152 Arthritic disorders, 115 Assessment and measurement, 63 burden-of-care measures, 103-104 cognitive functioning, 144 conceptual trends, 102 functional limitations, 101, 102-105, 108, 146 for hearing impairment, 133-134 hearing impairment as obstacle to, 136 individual differences in degree of disability, 79-80 of lifting limitations, 118, 119 of neuromuscular function, 93 outcomes research, 174-179 of speech limitation, 138, 140 terminology and taxonomy, 145, 378-381 tools for, 85 whole person, 102-103, 105, 144, 146 Assistive technology, 150-151, 182, 213-214, 257 ADRR research, 289 education and certification, 237 Association of Academic Physiatrists, 333 Association of Rehabilitation Nurses, 334-335 Ataxia, 103 Atrophy, 96 B Back pain, 11, 117 Balance, 109-111, 112 Barden-LaFollette Act, 34 Bending and lifting impairments, 117-119 Biological markers, 83 Biological sciences, 82, 83-84 Biomechanics, 92 Bladder control contextual disability, 124-125 disorders of, 122-123 functional limitations, 123-124 help-seeking behaviors, 123-124 quality of life issues, 124 research goals, 11 research needs, 126-127 secondary conditions related to, 125-126 Bowel control, 127-128 research goals, 11 Built environment, 150-152 Burden of care, 103-104 Bureau of Labor Statistics, 377 Bureau of the Census, 377 C Cartilage injury/repair, 91 Causes of cognitive impairment, 140-141 conceptual models, 63-64, 78-79 of disabilities, 2, 43-46 of disability among children, 48-51 of dysphagia, 120-121 of functional limitation, 11 of limitations in activities of daily living, 47 of paralysis, 94-95 primary attributions, 46 of sexual dysfunction, 128 of speech limitations, 138 of visual impairment, 129-130, 131 of work limitations, 46-47, 55 Centers for Disease Control and Prevention budget, 245, 266, 267 Disabilities Prevention Program, 266, 291-292, 358-360 education and training activities, 232-233

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--> National Center for Injury Prevention and Control, 360-362 rehabilitation research, 14, 266-268 structure and function, 232, 266 Centers for Organization, Delivery, and Financing of Health and Health-Related Services to People with Disabilities, 190 Cerebellar disorders, 110-111 Certification and credentialing assistive technology, 237 audiology and speech therapy, 239 occupational therapy, 239 orthotic and prosthetic professions, 239-240 rehabilitation counseling, 237 rehabilitation engineers, 236 rehabilitation medicine, 235 rehabilitation nursing, 236-237 Children activity limitations, 47-49 patterns of disability, 48-51 Chronic conditions, 51, 181 Circulatory disorders, 46, 47 Clinical practice guidelines, 208-209, 216 Cochrane Collaboration, 202 Cognitive functioning causes of limitation, 140-141 coping patterns, 163-164 as mediator of disability experience, 161-162 memory, 142 research needs, 142-144 technical aids for problems of, 142 types of impairment, 141-142 See also Psychological factors Compensation programs, 159 Conceptual models, 3 basis for rehabilitation science and engineering, 75-78 development process, 62-63 historical evolution, 63-64, 78-79, 147 person-environment interactions in, 79-80, 147, 148 role of, 62, 65 unidirectionality, 67 See also Modified IOM model Consumer Assistive Technology Transfer Network, 213-214 Consumer perspective, 171-172, 182-183, 207-208 participatory action research, 210 private rehabilitation organizations, 342-346 research goals, 220 in technology transfer, 215 Control beliefs, 162 Coping, 163-164 Cost-benefit/cost-effectiveness analysis, 174-179, 190, 203-204 Cost of disability and rehabilitation, 1, 2, 18, 40, 57-58, 61, 273 -274 advantages of early intervention, 55-56 benefits of functional improvement, 144-145 brain/spinal cord injury, 56-57 cost-effectiveness research, 174-176, 178-179 cost-of-illness methodology for estimating, 57-60 federal health care spending, 41 federal research spending, 14-15, 18, 274-276 financing long-term support services, 183-184 goals of managed care, 184 health care reform efforts, 172 recommendations for research funding, 20-21 research needs, 12-13, 173 subacute care, 176 urinary incontinence, 123 work-related, 57, 58-59 Cultural factors, 73 definition, 154 as determinants of disability, 147-148 in disabling process, 155-157 help-seeking behaviors, 155-156 in intrapsychic processes, 157 social institutions, 157 See also Social environment; Socioeconomic factors Current Population Survey, 54-55, 59, 61 D Department of Agriculture, 193-194, 195-196 Department of Defense, 272 Department of Education, 20-21, 283, 373, 375 See also National Institute for Disability and Rehabilitation Research

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--> Department of Energy, 374 Department of Health and Human Services, 21, 245, 272, 281, 283-286, 357-365, 374, 375 Department of Housing and Urban Development, 245, 365-367 Department of Justice, 376 Department of Transportation, 245, 367-369 Department of Veterans Affairs, 14, 41, 370-372 budget, 244, 262, 371 education and training activities, 234 research activities, 233-234, 261-266, 371-372 technology transfer activities, 193, 195, 198, 212 Disability definition, 5, 25, 101 definition for children, 47-48 scope of research, 11-12 Disabling process components, 5, 25 conceptual overview, 3, 6-8, 65-67, 147 See also Modified IOM model cultural factors, 155-157 economic system as factor in, 158-159 family factors, 165 mathematical modeling, 74-75 political system as factor in, 159-160 psychological factors in, 160-165 risk factors, 67 Down's syndrome, 48 Drooling, 121, 122 Dysarthria, 137-138 Dyslexia, 130-131 Dysphagia, 120-121 E Early intervention, 55-56 Eating hand/arm impairments, 116 impairments and functional limitations, 120-121 research needs, 122 research trends, 121-122 Economic factors. See Socioeconomic factors Education and training, 38 accrediting and credentialing systems, 234-240 ADRR responsibilities, 289-290 assistive technology, 237 audiology and speech therapists, 240 clinical research, 203-204, 206-207 design of academic programs, 241-242 in governmental institutions, 226-234 implications of new conceptual model, 80 knowledge sources, 224 mechanisms, 225-226 occupational therapy, 239 orthotic and prosthetic professions, 239 persons with disabilities, 231-232, 290 physical therapy, 238 primary care providers, 181 recommendations for, 190, 242-243 rehabilitation counseling, 237 rehabilitation engineers, 235-236 rehabilitation medicine, 235 rehabilitation nursing, 236-237 for research, 227, 228-231, 242-243, 253 Educational attainment, 55 Enabling factors, 71, 79 physical environment, 148-149 Enabling process conceptual models, 3, 6-8, 65-67, 220 See also Modified IOM model definition, 3, 24-25 economic system as factor in, 158-159 family factors, 165 goals, 3-5, 65 political system as factor in, 159-160 team approach, 26-27 Engineered environments ADRR research, 289 benefits of, 85 effectiveness, 152 research goals, 10 types of, 152 Engineering/physical sciences, 84-85 education of rehabilitation engineers, 236 Environmental factors, 1 built environment, 150-152 in cognitive functioning, 143-144 differences across settings, 79-80, 157 as enabling, 71, 79 in enabling-disabling process, 6-8, 11-12, 65-69, 71-73, 79-80, 148 , 167, 169 hand/arm therapies, 115-116 improving functional capacity, 144-145

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--> intrapersonal, 73 in managing incontinence, 124-125, 127 mathematical modeling, 74-75 in measuring degree of disability, 79-80 in models of disability, 63-64 natural environment, 149-150 physical supports for human performance, 148-149 range of, 148 research needs, 78, 167-169 research trends, 165-166 treatment conceptualization, 27 See also Access to environment; Cultural factors; Social environment Epidemiology activity limitation, 42 among children, 47-51 brain/spinal cord injury, 56, 57 data collection needs, 60, 78 data sources, 41, 52-53, 54, 59, 377 demographic distribution, 42, 55 demographic trends, 12 disability with primary cause, 46 family patterns, 51-52 geographic distribution, 42 influences on research, 171-172 prevalence of disabling conditions, 2, 40, 42-43, 54, 60-61 recommendations for data collection, 61 severity of disabling conditions, 2, 40, 54 types of disabling conditions, 2, 43-46 urinary incontinence, 123 work limitations, 46-47, 54-55, 58 Equal Employment Opportunity Commission, 376 Exercise, 86 neuromuscular retraining, 110-111 strength training, 100, 108-109 F Families, 51-52 in enabling-disabling process, 165 quantity and quality of care, 183-184 Federal research adequacy of, 272-276 agencies and programs, 244-247, 295-298, 352 See also specific agency or program consolidation of, 280-281 397 coordination of, 276-278 data sources, 377 effectiveness of, 38 evaluation of, methodology for, 327-330 opportunities to, 279-281 oversight, 246 spending, 14-15, 18, 244-245, 274-276 Focus group, 337-342 Food and Drug Administration, 191 Functional Capacity Index, 108 Functional limitations, 51 aging-related changes, 102, 104-105 assessment, 101, 102-105, 108, 146 bending and lifting, 117-119 bladder control, 122-127 bowel control, 127-128 causes of, 11 classification and terminology, 145 clinical taxonomy, 380 cognitive, 140-142 cross-cutting research issues, 102 cultural determinants, 155-157 definition, 5, 25, 101 dimensions of physical capacity, 108 in eating, 120-122 focus of rehabilitation, 101-102 hand/arm manipulation, 113-117 hearing, 132-136 impairment and, 100-102, 105 locomotor, 104, 108-113 mathematical modeling, 74-75 measurement, 100 recommendations for research, 145-146 research needs, 144-145 restoration goals, 3-5 scope of research, 10-11 secondary condition effects, 102, 104-105 sexual, 128-129 speech, 137-140 strength training, 100, 108-109 visual, 129-132 G Gait analysis, 90, 93 functional limitation, 101, 103 research needs, 111-113 strength training effects, 109, 110 Gender differences, 42 General Services Administration, 375-376

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--> Genetics research, 9-10, 83-84 gene therapy, 204 skeletal muscle disease, 95 Geographic factors, 148-149, 159 H Hand/arm manipulation arthritic disorders, 115 functional importance, 113 research needs, 116-117 surgical interventions, 113-115 therapeutic interventions, 115 Health services research, 12-13, 86 acute care, 173, 179 chronic disease risk, 181 cost-effectiveness, 174-179 data needs, 188, 190 delivery system, 171 in existing disciplines, 218-220 influences on, 171-172 limitations of, 170-171 long-term needs of persons with disability, 179-184, 205-206 managed care issues, 184-187 primary care delivery, 180-182 priorities, 12-13, 172, 173 recommendations, 189-190 risk adjustment, 187 scope, 12, 172-173 transdisciplinary collaboration for, 188-189 Hearing impairment among children, 48 certification of therapists for, 240 environmental design for, 135-136 functional limitations, 132-136 interventions, 134-135 prevalence, 43 research needs, 136 research trends, 11 Help-seeking behaviors cultural factors, 155-156 economic factors, 158 urinary incontinence, 123-124 I Impairment aging-related changes, 104-105 balance, 109-111 benefits of research, 97-98 categories of activity limitations, 81-82 clinical taxonomy, 378-379 cognitive, 140-144 cultural determinants, 156 definition, 5, 25 eating, 120-122 elimination function, 122-128 functional limitation and, 100-102, 105 hand/arm, 113-117 hearing, 132-136 lifting capacity, 117-119 locomotor, 108-113 mathematical modeling, 74-75 preclinical studies, 81 prevalence, 42-43 research domains, 9-10, 81, 82-87 research needs, 97, 98 sexual functioning, 128-129 speech, 136-140 strength, 108-109 vision, 129-132 Incontinence. See Bladder control; Bowel control Independent living movement, 171-172 Instrumental activities of daily living causes of limitations in, 47 functional limitations assessment, 103-104 prevalence of disabling conditions, 42 Insurance, 144-145 clinical research and, 205, 216 Interagency Committee on Disability Research (ICDR), 21, 41, 253, 256, 259-262, 277, 282 L Learning disability/mental retardation among children, 48 as main cause of impairment, 46 prevalence, 43 work limitations related to, 47 Lifestyle/behavioral factors, 6-8 Ligament injury/repair, 90-91 Locomotor function, 104, 108-113 Long-term care access issues, 182-183 delivery issues, 183-184 in managed care systems, 186

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--> primary care issues, 180-182 research needs, 12-13, 173, 182-183, 205-206 significance of, 179-180 Longitudinal research, 178, 190 M Managed care clinical research reimbursement, 205, 216 delivery systems, 184 effectiveness, 184-186 goal, 184 medical decision-making, 207 recommended research, 190 rehabilitative care trends in, 175-176 research needs, 13, 173, 184-187 risk adjustment/risk management, 187 Mathematical modeling, 74-75 of neuromuscular function, 93 Medicaid, 205 Medical decision-making clinical research basis, 202-203 consumer rights, 171-172 cost-effectiveness analysis, 174-175 in managed care, 207 practice guidelines for, 208-209 Medical management/treatment access to, in model of enabling process, 71 acute care, 173, 179 consumer participation, 171-172 cost of disabilities, 57-58, 174, 273-274 federal disability-related spending, 41 long-term support services, 182-183 primary care, 180-182 subacute care, 175-176 transfer of research findings, 38 trends, 175 See also Health services research; Therapeutic process/technique Medicare, 205 Medlantic Research Institute, 334 Memory impairment, 142 Mental retardation. See Learning disability/Mental retardation Mobility and ambulation, 111 Modified environments. See Engineered environments Modified IOM model distinguishing features, 64, 67-69 enabling-disabling process in, 6-8, 65-71 historical evolution, 63-64 implications for policy, 80 implications for research, 79-80 implications for training, 80 macrosystems/ mesosystems/ microsystems, 73, 159 mathematical modeling for, 74-75 person-environment interactions in, 72-73, 148 psychological factors in, 73 rationale, 67 recommendations for, 80 representation of disability in, 69-70, 73-74 representation of environment in, 69, 71-72 representation of individual in, 69, 70-71 risk factors, 71 transitional factors, 71 Molecular biology, 9-10, 82, 83-84 Mortality, as public health measure, 2, 24 Muscle repair, 10 historical technical development, 29 Musculoskeletal/tissue disorders, 43, 46, 47 among children, 48 atrophy, 96 clinical taxonomy, 378-379 current understanding and interventions, 87, 89-97 genetically associated, 83-84 healing processes, 90-91 neuromuscular system, 91-93 paralysis, 94-96 soft tissue injury, 90-91 synovial joints, 89-90 tissue grafts, 90-91 Myasthenia gravis, 94 N National Aeronautics and Space Administration, 374 National Cancer Institute, 196, 199 National Center for Health Statistics, 377 National Center for Medical Rehabilitation Research, 14, 41 budget, 205, 244-245, 253, 362

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--> education and training activities, 228-231 opportunities for improving, 291 organization and operations, 227-228 research activities, 228, 253-256, 362-363 structure and function, 251, 252-253 National Disability Statistics and Policy Forum, 60 National Health Interview Survey, 78 design, 41, 42 disability supplement data, 52-53 findings, 42-52 recommendations for, 61, 190 National Institute for Disability and Rehabilitation Research (NIDRR) , 34 budget, 15, 151, 244, 256-259, 355 education and training activities, 226-227 origins and development, 36 recommendations for, 1-2, 16-18, 20-21, 282-283, 295-296 research activities, 14, 226, 256-261, 277-278, 355-356 strategies for improving, 279-280, 281-282 structure and function, 41, 151, 226, 256, 354-355 technology transfer activities, 195, 199, 212-214 National Institute on Deafness and Other Communication Disorders, 374 National Institutes of Health clinical research funding, 205 disability-related research, 41, 246, 247-252, 276-277 recommendations for, 99, 145, 169 structure and function, 247 technology transfer activities, 199, 211-212 See also National Center for Medical Rehabilitation Research National Rehabilitation Information Center, 214, 356 National Science Foundation budget, 245, 268 education and training activities, 231-232 rehabilitation research, 14, 268-272, 372-373 structure and operations, 231, 268 Neurological disorders, 46, 47 among children, 48 bladder control, 122-123 clinical taxonomy, 379 hearing impairments related to, 133 neuromuscular injury and repair, 91-93 paralysis, 94-96 See also Spinal cord/brain injuries Neuroscience research, 10, 83, 87-89, 143 Nursing, 219, 236 O Occupational therapy accreditation and certification, 239 historical development, 29, 34, 36 mission, 239 vocational rehabilitation, 36 Office of Disability, Aging, and Long-Term Care Policy, 245, 272, 363-365 Optimism, 164 Orthopedic disorders among children, 48 as main cause of impairment, 46 prevalence, 43 work limitations related to, 46-47 Orthopedic medicine historical development of rehabilitation science, 32 research needs, 113 Orthotics certification for, 240 research needs, 113 role of, 239 Outcomes research, 203-204 attitude as outcome mediator, 164 on clinical investigations, 206-207 cost-benefit/cost-effectiveness analysis, 178-179 current inadequacy, 176-179 exercise intervention, 108-111 longitudinal studies, 178 need for, 174-176 quality of life measures, 176-177 use of comparison groups, 177 P Pacemakers, 92 Pain, 101 functional limitation assessment, 108 Paralysis causes, 94-95 effects, 94 therapies, 95-96 work limitations related to, 47 Paralyzed Veterans of America, 335-336 Participatory action research, 210 Pathology among children, 48-51 benefits of research, 97-98 categories of activity limitations, 81-82 central nervous system dysfunction, 87 chronic conditions causing disability, 51 cultural factors in, 154-156 definition, 5, 25 disease markers, 83 economic factors in course of, 158 federal research efforts, 249 mathematical modeling, 74-75 preclinical studies, 81 prevalence of disabling conditions, 43-46 research domains, 9-10, 81, 82-87 research needs, 97, 98 sexual dysfunction, 128 speech limitations, 138 visual impairment, 130, 131 Peer review process, 259 Personality factors, 164 Pharmacology research, 10, 84 technology transfer, 192 Physiatry, 30, 235 Physical therapy accredited programs, 238 historical development, 29, 30 practitioner supply, 238-239 professional activities, 30, 238 research for rehabilitation science, 86, 219 tissue healing processes, 90 Policymaking, 80, 159-160 consumer influence, 172 public health research for, 219-220 Polio, 30-31 President's Committee on Employment of Persons with Disabilities, 376 President's Committee on Mental Retardation, 376 Prevention, 67 home and recreational injuries, 360 primary care issues, 180-182 research for, 267-268 violence, 360, 361 Professional associations, 30, 34, 331-337 Professional development/standing, 37-38 academic programs for, 241-242 accrediting and credentialing systems, 234-240 ADRR activities, 289-290 implications of health care reform, 172 need for new discipline of rehabilitation science and engineering, 221-226, 294 opportunities for, 13-14 recommendations for, 18-19, 294 technology transfer mechanisms, 201-203 Project ACTION, 369-370 Prosthetics, 10 certification for, 240 engineering advancements, 111 hand/arm, 116-117 historical development, 28, 29, 30-31, 32-34 neuromuscular system, 92 research areas, 85 role of, 239-240 utilization, 183 Psychological factors in back pain-related work limitation, 119 control beliefs, 162 coping patterns, 163-164 as environmental mediators of disability experience, 148, 160-161, 164-165 in models of enabling-disabling process, 73 personality disposition, 164 research needs, 165 self-efficacy beliefs, 161-162 social cognitive processes, 161 social-cultural influences on, 157 training of rehabilitation counselors, 237 See also Cognitive functioning Q Quality of life as measure of public health, 2, 24 as outcomes measure, 176-177 urinary incontinence and, 124

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--> R Race/ethnicity prevalence of disabling conditions, 42, 51-52 prevalence of work disability, 55 Randomized controlled trials, 177, 201 Rehabilitation Act of 1973, 36 Rehabilitation counseling, 237 Rehabilitation engineering, 34, 236, 249, 253, 258, 269 ADRR research, 289 Rehabilitation medicine, 235 historical development, 28-36 See also Medical management/treatment Rehabilitation Nurses Foundation, 334-335 Rehabilitation process. See Enabling process Rehabilitation science and engineering accrediting and credentialing systems, 234-240 conceptual matrix for, 75-78 contributions of, 14 definition and scope, 5, 13-14, 25, 75-78, 223-225 design of academic programs for, 241-242 general priorities, 1, 19 historical development, 27-36 integration of research disciplines, 219-221 need for new discipline of, 221-223, 225-226, 294 need for review of systems, 2-3, 36-38 paradigms of, 224-225 purpose, 224 research domains, 8-9, 13, 14 scientific disciplines in, 9-10, 82, 218-219, 242 uniqueness of research project, 86-87 See also Education and training; Professional development/standing Rehabilitation team, 26-27, 28-29 Reproductive biology, 129 Research activities, 1 Research system clinical research, 203-207 conceptual matrix for rehabilitation science, 75-78 current organization and administration, 13-18, 38, 41, 272-278 data collection, 60, 61, 78 education and training, 227, 228-231, 242-243 funding, 296-298 historical development in U.S., 32-36 opportunities for improvement, 16 peer review process, 21, 99 policy decisions, 160 priorities, 19, 294-295 priority setting, 87, 99 public access to, 215, 216, 290-291 recommendations for, 19-21, 61, 98-99, 145-146, 167-169, 43, 296-298 team approach, 27 technology transfer process, 13 uniqueness of rehabilitation science and engineering, 86-87 See also Federal research; Technology transfer Research topics balance impairment, 109-111 biological sciences, 9-10, 82, 83-84 bladder control, 126-127 cognitive functioning, 142-144 disability, 11-12 domains of rehabilitation science and engineering, 8-9 eating limitations, 121-122 enabling factors, 79 engineering/physical sciences, 84-85 environmental factors, 165-169 functional limitation, 9-10, 102-105, 144-146 hand/arm therapies, 116-117 hearing impairment, 136 human musculoskeletal systems, 87-97 lifting limitations, 118-119 locomotion, 111-113 measurement of disability, 79-80 outcomes, 174-179, 203-204 pathology and impairment, 9-10, 81, 82-87, 97-98 pharmacological, 10, 84 public health, 219-220 randomized controlled trials, 177, 201 sexual functioning, 129 skeletal muscle, 93-97 social/behavioral sciences, 82, 85-86

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--> speech rehabilitation, 140 strength training mechanisms and outcomes, 108-109 translational, 203-204 visual impairment, 131-132 See also Health services research Respiratory disorders, 46 among children, 48 Risk adjustment/risk management, 187 Risk factors, 67 enabling factors and, 71 in modified IMO model, 71 Robotics, 92-93 S Sandia National Laboratories, 334 Secondary conditions, 205-206 in bladder impairment, 125-126 definition, 5, 25, 104 functional limitations assessment, 102, 104-105 prevention, 180 risk for persons with disability, 180 Self-efficacy beliefs, 161-162 Sensory stimulation as enabling factor, 149 See also Hearing impairment; Visual impairment Severity of disabling conditions educational attainment and, 55 environmental determinants, 73, 147-148 epidemiology, 2, 40, 54 hearing impairment, 133-134 obstacles to measurement, 79-80 Sexual functioning, 128-129 Sign language, 132, 134 Smith-Fess Act, 34 Social/behavioral sciences, 82, 85-86 Social environment animal companionship, 86 cognitive impairment and, 143 components of, 154 economic system, 158-159 family functioning, 165 institutions of, 157 modified IOM model, 69, 72-74 participatory action research, 210 physical environment and, 148 political system, 159-160 societal limitations model, 64, 67 See also Cultural factors Social Security Administration, 245, 272 Socioeconomic factors, 54, 55, 158-159 among families with disabled members, 52 as determinant of disability, 73 Speech impairments assessment, 138 functional limitations, 137 research needs, 140 therapeutic interventions, 138-140 types of, 137-138, 139 Spinal cord/brain injuries benefits of early intervention, 55-56 cognitive impairment, 140-142 current understanding and interventions, 87-89 economic costs, 56-57 prevalence, 56, 57 research trends, 10, 11 Strength training, 100, 108-109 Stuttering, 139 Subacute care, 175-176 Surgical interventions attitude as outcome mediator, 164 hand/arm, 113-115 Survey of Income and Program Participation, 54, 61 T Taxonomy, 145, 378-381 Technology-Related Assistance for Individuals with Disabilities Act , 150-151 Technology transfer, 38 ADRR activities, 290-291 barriers, 200-201, 214 benefits, 200 clinical practice guidelines in, 208-209 clinical practice mechanisms, 201-203 clinical research for, 203-208, 216 definition, 13, 191 difficulty of, 191 federal mechanisms, 210-214 federal role, 198-200 funding, 201 goals, 191, 199-200, 214 implementation, 13 incentives, 207-208

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--> legal environment, 195 market considerations, 198 models for, 193-194, 195-196 obstacles to, 13 organizational structures for, 194-196 participatory action research, 210 promoters of, 196-198 recommendations, 214-216, 295 sources of technology, 194 unique needs of rehabilitation science, 192-193 Therapeutic process/technique bladder control interventions, 126-127 for cognitive impairment, 142-144 for disuse atrophy, 96 drooling interventions, 122 eating limitation interventions, 121-122 economic benefits of early intervention, 55-56 exercise intervention outcomes, 108-111 hand/arm interventions, 113-117 for hearing impairment, 134-135 historical development, 27-34 research for rehabilitation science, 82, 86 skeletal muscle paralysis, 95-96 for soft tissue injury, 90 for speech limitations, 138-140 for spinal cord/brain injuries, 87-89 for synovial joint rehabilitation, 90-91 team approach, 26-27 See also Medical management/treatment Transitional factors, 71 cultural, 155-157 U United States Information Agency, 377 Universal design, 151-152 ADRR research, 289 V Veterinary science, 86 Visual impairment among children, 48 causes of, 129-130 certification of therapists for, 240 functional limitations, 129-131 as main cause of impairment, 46 prevalence, 43 research needs, 131-132 research trends, 11 technical aids for, 131 work limitations related to, 47 Vocational rehabilitation, 36. See also Occupational therapy W Wheeled locomotion, 113 toilet access, 125 universal design for, 150 Work limitations back pain, 119 bending and lifting impairments, 117-118 bladder control, 124-125 community factors, 158 cost estimates, 57, 58-59 environmental determinants of disability, 73 epidemiology, 46-47, 54-55 models of disability, 63-64 rehabilitation outcomes research, 178 research needs, 60 rights of job applicants and workers, 159-160