How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Impacts of institutional rules and spatial context on public management

Public management occurs within institutional and spatial contexts that define constraints and shape opportunities for public action. Importantly, the creation, adaptation, and nurture of institutions are socially valuable results of governmental action. Similarly, all human action occurs in and has effects in spatial contexts. The quality of life available to humans is dramatically affected by location and making places more valuable is an important goal of much public policy. Analyses at the nation state level find government creation and maintenance of institutional rules supporting democratic polities and market-based economies are the most important factors in the long-term economic performance of nations. When considering institutional context at the regional and local levels, or in specific policy arenas, at least three measures—(1) existing capacity for collective action; (2) complexity; and (3) volatility—need to be considered. Spatial contexts can be usefully analyzed along several dimensions, including structure of the economy, distribution of assets/liabilities and public, business, nonprofit and household activities, geography and population dynamics, among others. Estimating transaction costs of collective action can be a common entry point into analyses of institutional and spatial contexts. Both analysis and practice of public management will be advantaged by systematic attention to institutional and spatial context. #Adapted and expanded from papers presented at the 6th National Public Management Research Conference, Bloomington, IN, October 2001, and at the Annual Meeting of the American Political Science Association, San Francisco, CA, August–September 2001. © 2003, Taylor & Francis Group, LLC