From: The American Physical Therapy Association Weekly Email Bulletin

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INSTITUTE OF MEDICINE
Enabling America: Assessing the Role of Rehabilitation Science and Engineering 
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National Academy Press, 1997, $47.95.

[AUTHOR]
Institute of Medicine

[BIBLIOGRAPHIC DATA]
ISBN: 0309063744, LCCN: 97-21183, LC: RM950.E53, Country of Origin: U.S.,
appendixes included, glossary included, 11 chapters, 404 pages, Contributors,
hard cover. 

[DOODY'S NOTES]
Primary audience is Rehabilitation Professionals.Secondary audience is Health
Policy Specialists.The book contains black-and-white illustrations.  The
contributors represent the specialties of health science policy, physical
medicine and rehabilitation, occupational medicine, orthopedic surgery, and
biomedical engineering.  Most come from universities and hospitals in the
U.S., including Washington Univ, Johns Hopkins, and Univ of Pittsburgh. 

[REVIEWER'S EXPERT OPINION]
W. Zev Rymer, MD, PhD (Rehabilitation Institute of Chicago)

**Description**
This book sets out to evaluate the current state of rehabilitation research
in the US, and to devise plans to rectify identified areas of weakness.  The
book is based on the deliberations of an Institute of Medicine panel,
established by Congressional request.  Panel members were drawn from many
rehabilitation-related disciplines.  The panel also received testimony from
multiple external sources. 

**Purpose**
The report asserts that rehabilitation research is vitally important, and is
likely to be of increasing impact as the nation ages.  The report further
argues that rehabilitation research is currently fragmented, and distributed
between many federal agencies, without coherent integration or oversight. 
Furthermore, while current expenditures on disabling illness are enormous,
funds targeting rehabilitation research and engineering are quite modest. 
Accordingly, the panel recommends that we 1) strengthen and legitimize the
discipline(s) of rehabilitation science and engineering; 2) emphasize
fundamental research on the enabling-disabling process; and 3) reorganize
current rehabilitation research under a new agency, to be based within DHHS. 
Evaluation of the book is, in essence, a critique of this plan.  

**Audience**
The book is aimed at clinicians, researchers, and policymakers.

**Features**
Although the book is an important document which focuses most basically on
discussion, I do not believe that the recommended plan will work.  To begin,
it is not clear that the functional impact of disabling illnesses can
legitimately be separated from the illnesses themselves, an apparent
requirement of this new "science."   Furthermore, as a matter of politics, it
is unlikely that the disabled community will support the transfer of the
NIDDR to an agency which emphasizes disease related models as the primary
framework for support. 

**Assessment**
It may have served the nation better if the group had described the proposed
solutions broadly, and deferred specific legislative recommendations to
congressional committees.  As it stands, this book must be evaluated on the
basis of its primary recommendations, which appear unlikely to be successful.