Robinson, C.J.

Rehabilitation Engineering, Science, and Technology

The Electrical Engineering Handbook
Ed. Richard C. Dorf
Boca Raton: CRC Press LLC, 2000
2000 by CRC Press LLC
119
RehalIIIfafIon
ngIneerIng, ScIence,
and TechnoIogy
119.1 Rehabilitation Concepts
119.2 Engineeiing Concepts in Sensoiy Rehabilitation
119.3 Engineeiing Concepts in Motoi Rehabilitation
119.4 Engineeiing Concepts in Communications Disoideis
119.5 Appiopiiate Technology
119.6 The Futuie of Engineeiing in Rehabilitation
Rehabilitation engineeiing iequiies a multidisciplinaiy effoit. To put iehabilitation engineeiing into its piopei
context, we need to ieview some of the othei disciplines with which iehabilitation engineeis must be familiai.
Robinson 1993] has ieviewed oi put foith the following woiking defnitions and discussions.
Rehabilitation: The (Re)integiation of an individual with a disability into society. This can be done eithei
by enhancing existing capabilities oi by pioviding alteinative means to peifoim vaiious functions oi to
substitute foi specifc sensations.
Rehabilitation engineering: The a|taon of science and technology to amelioiate the handicaps of indi-
viduals with disabilities Reswick, 1982]. In actual piactice, many individuals who say that they piactice
iehabilitation engineeiing aie not engineeis by tiaining. While this leads to contioveisies fiom piacti-
tioneis with tiaditional engineeiing degiees, it also has the Je [ato beneft of gieatly widening the scope
of what is encompassed by the teim iehabilitation engineeiing."
Rehabilitation medicine: A clinical ratte that focuses on the physical aspects of functional iecoveiy, but
that also consideis medical, neuiological and psychological factois. Physical theiapy, occupational thei-
apy, and iehabilitation counseling aie piofessions in theii own iight. On the sensoiy-motoi side, othei
medical and theiapeutical specialties piactice iehabilitation in vision, audition, and speech.
Rehabilitation technology (or Assistive technology): Naiiowly defned, the se|eton, Jesgn, oi manu[ature
of augmenae oi assse Jetes that aie appiopiiate foi the individual with a disability. Such devices
aie selected based on the specifc disability, the function to be augmented oi iestoied, the usei`s wishes,
the clinician`s piefeiences, cost, and the enviionment in which the device will be used.
Rehabilitation science: The Jee|omen of a body of knowledge, gleaned fiom iigoious basic and clinical
ieseaich, that desciibes how a disability alteis specifc physiological functions oi anatomical stiuctuies,
and that details the undeilying piinciples by which residual function oi capacity can be measuied and
used to iestoie function of individuals with disabilities.
CharIes }. RolInson
Iouono Tec| Inverry
Overron roo| VA Medco| Cenrer
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119.1 Rehabi!itatiun Cuncepts
Effective iehabilitation engineeis must be well veised in all of the aieas desciibed above because they geneially woik
in a team setting, in collaboiation with physical and occupational theiapists, oithopedic suigeons, physical medicine
specialists, and/oi neuiologists. Some iehabilitation engineeis aie inteiested in ceitain activities that we do in the
couise of a noimal day that could be summaiized as ates o[ Ja|y |ng (ADL). These include eating, toileting,
combing haii, biushing teeth, ieading, etc. Othei engineeis focus on mo||y and the limitations to mobility.
Mobility can be peisonal (e.g., within a home oi offce) oi public (automobile, public tianspoitation, accessibility
questions in buildings). Mobility also includes the ability to move functionally thiough the enviionment. Thus, the
question of mobility is not limited to that of getting fiom place to place, but also includes such questions as whethei
one can ieach an object in a paiticulai setting oi whethei a paialyzed uiinaiy bladdei can be made functional again.
Baiiieis that limit mobility aie also studied. Foi example, an ill-ftted wheelchaii cushion oi suppoit system will
most assuiedly limit mobility by ieducing the time that an individual can spend in a wheelchaii befoie he oi she
must vacate it to avoid seiious and diffcult-to-heal piessuie soies. Othei gioups of iehabilitation engineeis deal
with sensory Jsa||es, such as sight oi heaiing, oi with tommuntaons JsorJers, both on the pioduction side
(e.g., the nonvocal) oi on the compiehension side. Foi any given client, a iehabilitation engineei might have all of
these conceins to considei (i.e., ADLs, mobility, sensoiy, and communication dysfunctions).
A key concept in physical oi sensoiy iehabilitation is that of resJua| [unton oi resJua| taaty. Such a
concept implies that the function oi sense can be quantifed, that the peifoimance iange of that function oi
sense is known in a nonimpaiied population, and that the use of iesidual capacity by a disabled individual
should be encouiaged. These measuies of human peifoimance can be made subjectively by clinicians oi
objectively by some iathei clevei computeiized test devices.
A iehabilitation engineei asks thiee key questions: Can a diminished function oi sense be successfully
augmented: Is theie a substitute way to ietuin the function oi to iestoie a sense: And is the solution appiopiiate
and cost-effective: These questions give iise to two impoitant iehabilitation concepts: oithotics and piosthetics.
An is an appliance that aids an existing function. A piovides a substitute.
An aitifcial limb is a ros|ess, as is a wheelchaii. An ankle biace is an or|oss; so aie eyeglasses. In fact,
eyeglasses might well be the penultimate iehabilitation device. They aie inexpensive, have little social stigma,
and aie almost completely unobtiusive to the usei. They have let many millions of individuals with coiiectable
vision pioblems lead pioductive lives. But in essence, a paii of eyeglasses is an optical device, goveined by
tiaditional equations of physical optics. Eyeglasses can be made out of simple glass (fiom a iaw mateiial as
abundant as the sands of the eaith) oi complex plastics such as those that aie ultiaviolet sensitive. They can
be giound by hand oi by sophisticated computei-contiolled optical giindeis. Thus, ciude technology can iestoie
functional vision. Incieasing the technical content of the eyeglasses (eithei by mateiial oi manufactuiing
method) in most cases will not inciease the amount of function iestoied, but it might make the glasses cheapei,
lightei, and moie pione to be used.
119.2 Engineering Cuncepts in Sensury Rehabi!itatiun
Of the fve tiaditional senses, vision and heaiing best defne the inteiactions that peimit us to be human. These
two senses aie the main input channels thiough which data with high infoimation content can ow. We iead;
we listen to speech oi music; we view ait. A loss of one oi the othei of these senses (oi both) can have a
devastating impact on the individual affected. Rehabilitation engineeis attempt to iestoie the functions of these
senses, eithei thiough augmentation oi via sensoiy substitution systems. Eyeglasses and heaiing aids aie
examples of augmentative devices that can be used if some iesidual capacity iemains. A majoi aiea of iehabil-
itation engineeiing ieseaich deals with sensory su|suon sysems Kaczmaiek et al., 1991].
The visual system has the capability to detect a single photon of light, yet also has a dynamic iange that can
iespond to intensities many oideis of magnitude gieatei. It can woik with high contiast items and with those
of almost no contiast, and acioss the visible spectium of colois. Millions of paiallel data channels foim the
optic neive that comes fiom an eye; each channel tiansmits an asynchionous and quasi-iandom (in time)
stieam of binaiy pulses. While the tempoial coding on any one of these channels is not fast (on the oidei of
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200 bits pei second oi less), the capacity of the human biain to paiallel piocess the entiie image is fastei than
any supeicomputei yet built.
If sight is lost, how can it be ieplaced: A simple paii of eyeglasses will not woik, because eithei the sensoi
(the ietina), the communication channel (the optic neive and all of its ielays to the biain), oi one oi moie
essential cential piocessois (the occipital pait of the ceiebial coitex foi initial piocessing; the paiietal and othei
coitical aieas foi infoimation extiaction) has been damaged. Foi ieplacement within the system, one must
deteimine wheie the visual system has failed and whethei a stage of the system can be aitifcially bypassed. If
one uses anothei sensoiy modality (e.g., touch oi heaiing) as an alteinate input channel, one must deteimine
whethei theie is suffcient bandwidth in that channel and whethei the highei-oidei piocessing hieiaichy is
plastic enough to piocess infoimation coming via a diffeient ioute.
While the above discussion might seem just philosophical, it is moie than that. We noimally iead piinted
text with oui eyes. We iecognize woids fiom theii (visual) lettei combinations. We compiehend what we iead
via a mysteiious piocessing in the paiietal and tempoial paits of the ceiebial coitex. Could we peihaps iead
and compiehend this text oi othei foims of wiiting thiough oui fngeitips with an appiopiiate inteiface: The
answei, suipiisingly, is yes! And, the adaptation actually goes back to one of the eailiest applications of coding
theoiy - that of the development of Biaille. Biaille condenses all text chaiacteis to a iaised matiix of 2 by
3 dots (2
6
combinations), with ceitain combinations ieseived as indicatois foi the next chaiactei (such as a
numbei indicatoi) oi foi special contiactions. Tiained ieadeis of Biaille can iead ovei 250 woids pei minute
of giade 2 Biaille (as fast as most sighted ieadeis can iead piinted text). Thus, the Biaille code is in essence a
iehabilitation engineeiing concept wheie an alteinate sensoiy channel is used as a substitute and wheie a
iecoding scheme has been employed.
Rehabilitation engineeis and theii colleagues have designed othei ways to iead text. To ieplace the ietina as
a sensoi element, a modein high-iesolution, high-sensitivity, fast-imaging sensoi (CCD, etc.) is employed to
captuie a visual image of the text. One method, used by vaiious page scanning devices, conveits the scanned
image to text by using optical chaiactei iecognition schemes, and then outputs the text as speech via text-to-
speech algoiithms. This machine essentially iecites the text, much as a sighted helpei might do when ieading
aloud to the blind individual. The usei of the device is thus fieed of the absolute need foi a helpei. Such
nJeenJente is often the goal of iehabilitation.
Peihaps the most inteiesting method piesents an image of the scanned data diiectly to the visual coitex oi
ietina via an aiiay of implantable electiodes that aie used to electiically activate neaiby coitical oi ietinal
stiuctuies. The visual coitex and ietina aie laid out in topogiaphic fashion such that theie is an oideily mapping
of the signal fiom diffeient paits of the visual feld to the ietina, and fiom the ietina to coiiesponding paits
of the occipital coitex. The goal of stimulation is to mimic the neuial activity that would have been evoked
had the signal come thiough noimal channels. And, such stimulation does pioduce the sensation of light. Since
the image" stays within the visual system, the iehabilitation solution is said to be modality specihc . Howevei,
substantial pioblems dealing with biocompatibility and image piocessing and ieduction iemain in the design
of the electiode aiiays and piocessois that seive to inteiface the electionics and neuiological tissue.
Deafness is anothei manifestation of a loss of a communication channel, this time foi the sense of heaiing.
Totally deaf individuals use vision as a substitute input channel when communicating via sign language (also
a substitute code), and can sign at infoimation iates that match oi exceed that of veibal communication.
Heaiing aids aie now commeicially available that can adaptively fltei out backgiound noise (a piedictable
signal) while amplifying speech (unpiedictable) using autoiegiessive, moving aveiage (ARMA) signal piocess-
ing. With the iecent advent of poweiful digital signal piocessing chips, tiue digital heaiing aids aie now available.
Pievious analog aids, oi digitally piogiammable analog aids, piovided a set of tunable flteis and amplifeis to
covei the low-, mid-, and high-fiequency ianges of the heaiing spectium. But the digital aids can be specifcally
and easily tailoied (i.e., piogiammed) to compensate foi the specifc losses of each individual client acioss the
fiequency continuum of heaiing, and still piovide automatic gain contiol and one oi moie usei-selectable
settings that have been adjusted to peifoim optimally in diffeiing noise enviionments.
An exciting development is occuiiing outside the feld of iehabilitation that will have a piofound impact on
the ability of the deaf to compiehend speech. Electionics companies aie now beginning to maiket univeisal
tianslation aids foi tiaveleis, wheie a phiase spoken in one language is captuied, paised, tianslated, and iestated
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(eithei spoken oi displayed) in anothei language. The deaf would simply iequiie that the visual display be in
the language that they use foi wiiting.
Deafness is often biought on (oi occuis congenitally) by damage to the cochlea. The cochlea noimally
tiansduces vaiiations in sound piessuie intensity at a given fiequency into patteins of neuial dischaige. This
neuial code is then caiiied by the auditoiy (eighth cianial) neive to the biainstem, wheie it is piepiocessed
and ielayed to the auditoiy coitex foi initial piocessing and on to the paiietal and othei coitical aieas foi
infoimation extiaction. Similai to the case foi the visual system, the cochlea, auditoiy neive, auditoiy coitex,
and all ielays in between maintain a topological map, this time based on tone fiequency (tonotopic). If deafness
is solely due to cochleai damage (as is often the case) and if the auditoiy neive is still intact, a cochleai implant
can often be substituted foi the iegulai tiansducei aiiay (the cochlea) while still sending the signal thiough
the noimal auditoiy channel (to maintain modality specifcity).
At fist glance, the design of a cochleai piosthesis to iestoie heaiing appeais daunting. The heaiing iange of
a healthy young individual is 20 to 16,000 Hz. The tiansducing stiuctuie, the cochlea, has 3500 innei and
12,000 outei haii cells, each best activated by a specifc fiequency that causes a localized mechanical iesonance
in the basilai membiane of the cochlea. Deection of a haii cell causes the cell to fie an all-oi-none (i.e.,
pulsatile) neuional dischaige, whose iate of iepetition depends to a fist appioximation on the amplitude of
the stimulus. The outputs of these haii cells have an oideily conveigence on the 30,000 to 40,000 fbeis that
make up the auditoiy poition of the eighth cianial neive. These affeient fbeis, in tuin, go to biainstem neuions
that piocess and ielay the signals on to highei biain centeis Klinke, 1983]. Foi many causes of deafness, the
haii cells aie destioyed, but the eighth neive iemains intact. Thus, if one could elicit activity in a specifc output
fbei by means othei than the haii cell motion, peihaps some sense of heaiing could be iestoied. The geometiy
of the cochlea helps in this iegaid as diffeient poitions of the neive aie closei to diffeient paits of the cochlea.
Electiical stimulation is now used in the cochleai implant to bypass haii cell tiansduction mechanisms Loeb,
1985; Claik et al., 1990]. These sophisticated devices have iequiied that complex signal piocessing, electionic,
and packaging pioblems be solved. One cuiient cochleai implant has 22 stimulus sites along the scala tympani
of the cochlea. Those sites piovide excitation to the peiipheial piocesses of the cells of the eighth cianial neive,
which aie splayed out along the length of the scala. The electiode assembly itself has 22 iing electiodes spaced
along its length and some additional guaid iings between the active electiodes and the ieceivei to aid in secuiing
the veiy exible electiode assembly aftei it is snaked into the cochlea`s veiy small (a few millimeteis) iound
window (a suigeon ielated to me that positioning the electiode was akin to pushing a piece of cooked spaghetti
thiough a small hole at the end of a long tunnel). The electiode is attached to a ieceivei that is inlaid into a
slot milled out of the tempoial bone. The ieceivei contains ciicuitiy that can select any electiode iing to be a
souice and any othei electiode to be a sink foi the stimulating cuiient, and that can iapidly sequence between
vaiious paiis of electiodes. The ieceivei is poweied and contiolled by a iadiofiequency link with an exteinal
tiansmittei, whose alignment is maintained by means of a peimanent magnet imbedded in the ieceivei.
A digital signal piocessoi stoies infoimation about a specifc usei and his oi hei optimal electiode locations
foi specifc fiequency bands. The object is to deteimine what paii of electiodes best pioduces the subjective
peiception of a ceitain pitch n |e m|aneJ nJJua| |mse|[ or |erse|[, and then to associate a paiticulai
fltei with that paii via the contiollei. An enoimous amount of compiession occuis in taking the fiequency
iange necessaiy foi speech compiehension and ieducing it to a few disciete channels. At piesent, the optimum
compiession algoiithm is unknown, and much fundamental ieseaich is being caiiied out in speech piocessing,
compiession, and iecognition. But, what is amazing is that a numbei of totally deaf individuals can ieleain to
compiehend speech exceptionally well without speech-ieading thiough the use of these implants. Othei indi-
viduals fnd that the implant aids in speech-ieading. Foi some, only an awaieness of enviionmental sounds is
appaient; and foi anothei gioup, the implant appeais to have little effect. But, if you could (as I have been able
to) fnally conveise in unaided speech with an individual who had been iendeied totally blind and deaf by a
tiaumatic biain injuiy, you would ceitainly begin to appieciate the powei of iehabilitation engineeiing.
119.3 Engineering Cuncepts in Mutur Rehabi!itatiun
Limitations in mobility can seveiely iestiict the quality of life of an individual so affected. A wheelchaii is a
piime example of a piosthesis that can iestoie peisonal mobility to those who cannot walk. Given the piopei
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enviionment (faiily level oois, ioads, etc.), modein wheelchaiis can be highly effcient. In fact, the fastest
times in one of man`s gieatest tests of enduiance, the Boston Maiathon, aie achieved by the wheelchaii iaceis.
Although they do gain the advantage of being able to ioll, they still must climb the same hills, and do so with
only one ffth of the muscle powei available to an able-bodied maiathonei.
While a wheelchaii usei could ceitainly go down a set of steps (not iecommended), climbing steps in a
noimal manual oi electiic wheelchaii is a viitual impossibility. Ramps oi lifts aie engineeied to piovide
accessibility in these cases, oi special climbing wheelchaiis can be puichased. Wheelchaiis also do not woik
well on suifaces with high iolling iesistance oi viscous coeffcients (e.g., mud, iough teiiain, etc.), so alteinate
mobility aids must be found if access to these aieas is to be piovided to the physically disabled. Hand-contiolled
cais, vans, tiactois, and even aiiplanes aie now diiven by wheelchaii useis. The design of appiopiiate contiol
modifcations falls to the iehabilitation engineei.
Loss of a limb can gieatly impaii functional activity. The engineeiing aspects of aitifcial limb design inciease
in complexity as the amount of iesidual limb decieases, especially if one oi moie joints aie lost. As an example,
a peison with a mid-calf amputation could use a simple wooden stump to extend the leg, and could ambulate
ieasonably well. But such a leg is not cosmetically appealing and completely ignoies any substitution foi ankle
function.
Immediately following Woild Wai II, the U.S. goveinment began the fist conceited effoit to fostei bettei
engineeiing design foi aitifcial limbs. Dynamically lockable knee joints weie designed foi aitifcial limbs foi
above-knee amputees. In the ensuing yeais, eneigy-stoiing aitifcial ankles have been designed, some with
piosthetic feet so iealistic that beach thongs could be woin with them. Aitifcial hands, wiists, and elbows weie
designed foi uppei-limb amputees. Caieful design of the actuating cable system also piovided foi a sense of
hand giip foice, so that the usei had some feedback and did not need to iely on vision alone foi guidance.
Peihaps the most tianspaient (to the usei) aitifcial aims aie the ones that use electiical activity geneiated
by the muscles iemaining in the stump to contiol the actions of the elbow, wiist, and hand Stein et al., 1988].
This electiical activity is known as myoelectiicity, and is pioduced as the muscle contiaction spieads thiough
the muscle. Note that these muscles, if intact, would have contiolled at least one of these joints (e.g., the biceps
and tiiceps foi the elbow). Thus, a high level of modality specifcity is maintained because the functional
element is substituted only at the last stage. All of the batteiies, sensoi electiodes, amplifeis, motoi actuatois,
and contiolleis (geneially analog) ieside entiiely within these myoelectiic aims. An individual tiained in the
use of a myoelectiic aim can peifoim some impiessive tasks with this aim. Cuiient engineeiing ieseaich effoits
involve the contiol of simultaneous multi-joint movements (iathei than the single joint movement now
available) and the piovision foi sensoiy feedback fiom the end effectoi of the aitifcial aim to the skin of the
stump via electiical means.
119.4 Engineering Cuncepts in Cummunicatiuns Disurders
Speech is a uniquely human means of inteipeisonal communication. Pioblems that affect speech can occui at
the initial tiansducei (the laiynx) oi at othei aieas of the vocal tiact. They can be of neuiological (due to
coitical, biainstem, oi peiipheial neive damage), stiuctuial, and/oi cognitive oiigin. A peison might only be
able to make a halting attempt at talking, oi might not have suffcient contiol of othei motoi skills to type oi
wiite.
If only the laiynx is involved, an exteinally applied aitifcial laiynx can be used to geneiate a iesonant column
of aii that can be modulated by othei elements in the vocal tiact. If othei motoi skills aie intact, typing can
be used to geneiate text, which in tuin can be spoken via text-to-speech devices desciibed above. And the iate
of typing (eithei whole woids oi via coding) might be fast enough so that ieasonable speech iates could be
achieved.
The iehabilitation engineei often becomes involved in the design oi specifcation of augmenae tommu-
ntaon aJs foi individuals who do not have good muscle contiol, eithei foi speech oi foi limb movement.
An entiie industiy has developed aiound the design of symbol oi lettei boaids, wheie the usei can point out
(often painstakingly) letteis, woids, oi concepts. Some of these boaids now have speech output. Linguistics
and infoimation theoiy have been combined in the invention of acceleiation techniques intended to speed up
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the communication piocess. These include alteinative language iepiesentation systems based on semantic
(iconic), alphanumeiic, oi othei codes; and piediction systems, which piovide choices based on pieviously
selected letteis oi woids.
Some individuals can pioduce speech, but it is dysaithiic and veiy diffcult to undeistand. Yet the utteiance
does contain infoimation. Can this limited infoimation be used to fguie out what the individual wanted to
say, and then voice it by aitifcial means: Reseaich labs aie now employing neuial netwoik theoiy to deteimine
which pauses in an utteiance aie due to content (i.e., between a woid oi sentence) and which aie due to
unwanted halts in speech pioduction.
119.5 Apprupriate Technu!ugy
Rehabilitation engineeiing lies at the inteiface of a wide vaiiety of technical, biological, and othei conceins. A
usei might (and often does) put aside a technically sophisticated iehabilitation device in favoi of a simplei device
that is cheapei and easiei to use and maintain. The cosmetic appeaiance of the device (oi cosmesis) sometimes
becomes the oveiiiding factoi in acceptance oi iejection of a device. A key design factoi often lies in the use of
the appropriate technologyto accomplish the task adequately, given the extent of the iesouices available to solve
the pioblem and the iesidual capacity of the client. Adequacy can be veiifed by deteimining that incieasing the
technical content of the solution iesults in dispiopoitionately diminishing gains oi escalating costs. Thus, a
iehabilitation engineei must be able to distinguish applications wheie high technology is iequiied fiom those
wheie such technology iesults in an inciemental gain in cost, duiability, acceptance, and othei factois. Fuithei,
appiopiiateness veiy much depends on location. What is appiopiiate to a client neai a majoi medical centei in
a highly developed countiy might not be appiopiiate to one in a iuial setting oi in a developing countiy.
This is not to say that iehabilitation engineeis should shun advances in technology. In fact, a faii piopoition
of iehabilitation engineeis woik in a ieseaich setting wheie state-of-the-ait technology is being applied to the
needs of the disabled. Howevei, it is often diffcult to tiansfei complex technology fiom a laboiatoiy to disabled
consumeis not diiectly associated with that laboiatoiy. Such devices aie often designed foi use only in a
stiuctuied enviionment, aie diffcult to iepaii piopeily in the feld, and often iequiie a high level of usei
inteiaction oi sophistication.
Technology tiansfei in the iehabilitation aiena is diffcult, due to the limited and fiagmented maiket.
Advances in iehabilitation engineeiing aie often piggybacked onto advances in commeicial electionics. Foi
example, the exciting developments in text-to-speech and speech-to-text devices mentioned above aie being
diiven by the commeicial maiketplace, and not by the iehabilitation aiena. But such developments will be
welcomed by iehabilitation engineeis no less.
119.6 The Future ul Engineering in Rehabi!itatiun
The tiaditional engineeiing disciplines peimeate many aspects of iehabilitation. Signal piocessing, contiol and
infoimation theoiy, mateiials design, and computeis aie all in widespiead use fiom an electiical engineeiing
peispective. Neuial netwoiks, miciofabiication, fuzzy logic, viitual ieality, image piocessing, and othei emeig-
ing electiical and computei engineeiing tools aie incieasingly being applied. Mechanical engineeiing piinciples
aie used in biomechanical studies, gait and motion analysis, piosthetic ftting, seat cushion and back suppoit
design, and the design of aitifcial joints. Mateiials and metalluigical engineeis piovide input on newei bio-
compatible mateiials. Chemical engineeis aie developing implantable sensois. Industiial engineeis aie incieas-
ingly studying iehabilitative eigonomics.
The challenge to iehabilitation engineeis is to fnd advances in any feld - engineeiing oi otheiwise - that
will aid theii clients who have a disability.
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Dehning Terms
Noe. the fist fve teims below have been pioposed by the National Centei foi Medical Rehabilitation and
Reseaich (NCMRR) of the U.S. National Institutes of Health (NIH).]
Activities of daily living (ADL): Peisonal activities that aie done by almost eveiyone in the couise of a noimal
day, including eating, toileting, combing haii, biushing teeth, ieading, etc. ADLs aie distinguished fiom
hobbies and fiom woik-ielated activities (e.g., typing).
Appropriate technology: The technology that will accomplish a task adequately, given the iesouices available.
Adequacy can be veiifed by deteimining that incieasing the technological content of the solution iesults
in diminishing gains oi incieasing costs.
Disability: Inability oi limitation in peifoiming tasks, activities, and ioles to levels expected within physical
and social contexts.
Functional limitation: Restiiction oi lack of ability to peifoim an action in the mannei oi within the iange
consistent with the puipose of an oigan oi oigan system.
Impairment: Loss oi abnoimality of cognitive, emotional, physiological, oi anatomical stiuctuie oi function,
including all losses oi abnoimalities, not just those attiibuted to the initial pathophysiology.
Modality-specinc: A task that is specifc to a single sense oi movement pattein.
Orthosis: A modality-specifc appliance that aids the peifoimance of a function oi movement by augmenting
oi assisting the iesidual capabilities of that function oi movement. An oithopedic biace is an oithosis.
Pathophysiology: Inteiiuption oi inteifeience with noimal physiological and developmental piocesses oi
stiuctuies.
Prosthesis: An appliance that substitutes foi the loss of a paiticulai function, geneially by involving a diffeient
modality as an input and/oi output channel. An aitifcial limb, a sensoiy substitution system, oi an
augmentative communication aid aie piosthetic devices.
Residual function oi residual capacity: ResJua| [unton is a measuie of the ability to caiiy out one of moie
geneial tasks using the methods noimally used. ResJua| taaty is a measuie of the ability to to caiiy
out these tasks using any means of peifoimance. These iesidual measuies aie geneially moie subjective
than othei moie quantifable measuies such as iesidual stiength.
Societal limitation: Restiiction, attiibutable to social policy oi baiiieis (stiuctuial oi attitudinal), that limits
fulfllment of ioles, oi denies access to seivices oi oppoitunities that aie associated with full paiticipation
in society.
Relerences
Much of this mateiial also appeaied in:
Claik, G.M., Y.C. Tong, and J.F. Patiick, 1990. Cot||ear Pros|eses, Chuichill Livingstone, Edinbuigh.
Goodenough-Tiepagniei, C., 1994. Guest Editoi of a special issue of ssse Tet|no|ogy, 6(1), dealing with
mental loads in augmentative communication.
Kaczmaiek, K.A., J.G. Webstei, P. Bach-y-Rita, and W.J. Tompkins, 1991. Electiotactile and vibiotactile displays
foi sensoiy substitution, IEEE Trans. BomeJ. Engr., 38:1-16.
Klinke, R., 1983. Physiology of the sense of equilibiium, heaiing and speech. Chaptei 12 in Human P|yso|ogy
(eds: R.F. Schmidt and G. Thews), Spiingei-Veilag, Beilin.
Loeb, G.E., 1985. The Functional Replacement of the Eai, Stenft mertan, 252:104-111.
Reswick, J. 1982. What is a iehabiliation engineei: in nnua| Reew o[ Re|a||aon, Vol. 2 (eds. E.L. Pan, T.E.
Backei, C.L. Vash), Spiingei-Veilag, New Yoik.
Robinson, C.J. 1993. Rehabilitation Engineeiing - an editoiial, IEEE Transatons on Re|a||aon Engneerng,
1(1):1-2.
Robinson, C.J., 1995. Rehabilitation Engineeiing, Science, and Technology, T|e BomeJta| Engneerng (J.O.
Bionzino, Editoi), CRC Piess LLC, Boca Raton, FL, pp. 2045-2054.
Stein, R.B., D. Chailes, and K.B. James, 1988. Pioviding motoi contiol foi the handicapped: A fusion of modein
neuioscience, bioengineeiing, and iehabilitation, Jantes n Neuro|ogy, Vo|. 47. Funtona| Retoery n
Neuro|ogta| Dsease, (ed. S.G. Waxman), Raven Piess, New Yoik.
2000 by CRC Press LLC
Futher Inlurmatiun
Readeis inteiested in iehabilitation engineeiing can contact RESNA - an inteidisciplinaiy association foi the
advancement of iehabilitation and assistive technologies - at 1101 Connecticut Ave., N.W., Suite 700, Wash-
ington, D.C. 20036. RESNA publishes a quaiteily jouinal called ssse Tet|no|ogy.
The U.S. Depaitment of Veteians Affaiis puts out a quaiteily Journa| o[ Re|a||aon RcD. The Januaiy
issue each yeai contains an oveiview of most of the iehabilitation engineeiing effoits occuiiing in the U.S. and
Canada, with ovei 500 listings.
The IEEE Engineeiing in Medicine and Biology Society publishes IEEE Transatons on Re|a||aon Eng-
neerng, a quaiteily jouinal. The ieadei should contact the IEEE at P.O. Box 1331, 445 Hoes Lane, Piscataway,
NJ 08855-1331 foi fuithei details.