courses that have a direct bearing on State agency operations and the production of rehabilitants.

1967 proposed program.-In 1967, $2,467,000 is required for support of shortterm courses. This amount includes $1,133,000 for instructional costs and $1,334,000 for traineeships for about 7,060 individuals. It represents an increase of $101,000 above the requested 1966 level.

The courses will deal largely with the following subject-matter areas:

(1) Administration, supervision, and medical consultation in State vocational rehabilitation agencies;

(2) Advanced counseling and employment placement techniques;

(3) Rehabilitation of persons in such disability categories as the blind, the deaf, the mentally ill, the mentally retarded, the older disabled worker, and the disabled offender against the law;

(4) Administration of rehabilitation facilities, including courses on various phases of rehabilitation center administration and management of sheltered workshops and work adjustment centers;

(5) Improvement of the professional training of rehabilitation personnel through institutes or seminars designed to strengthen the content and methodology of instruction in the fields of medicine, rehabilitation counseling, social work, physical therapy, occupational therapy, and speech pathology-audiology ;

(6) Coordination and interagency cooperation between vocational rehabilitation agency personnel and other governmental programs, such as education of handicapped children, crippled children's services, public welfare, public health, employment service, and related programs;

(7) Prosthetics and orthotics for physicians, surgeons, therapists, prosthetists, orthotists, and rehabilitation counselors; and

(8) Others, including rehabilitation and labor health services, role of psychiatry in rehabilitation, dental management of handicapped persons.

SECTION D. RESEARCH FELLOWSHIPS

This section relates to the VRA regular research fellowship program initiated in December 1957 and the research training program initiated in fiscal year 1966 in heart disease, cancer, and stroke.

Accomplishments.-The purpose of research fellowships is to enlarge the program of research training in order to expand the pool of promising young investigators attacking the increasing rehabilitation problems for the vocational adjustment of disabled persons.

The program, since its inception in December 1957, has supported 125 individuals in the fields of rehabilitation specialization including psychological counseling, speech pathology and audiology, sociology, economics, social work, and medicine. The future career plans of all who are engaged in individual research included plans either to continue research in the field of vocational rehabilitation or to be involved in the teaching and supervision of research in this field. One of the interesting research areas studied was the relationship between brain damage, and age and cerebral insult, there was more confused intention rather than lost understanding in the intellectual performance of hemiplegic individuals. Another project dealt with the newest methods of research teaching in hand surgery with implications for vocational adjustment. Another study dealt with the problem of the relationship between articulation skill and language ability of those with speech problems. In the area of stroke, it was found in still another study that the process of thinking was no better indicator of brain damage than the correct solutions obtained within the studies.

In 1965, fellowships were awarded to 26 individuals; in 1966 an estimated 39 will be awarded fellowships, at an estimated cost of $160,000.

In 1966, it is expected that 100 fellowships will be awarded, totaling $500,000 for the purpose of giving physicians and professional personnel in related fields an opportunity for advanced training in research problems of cardiovascular diseases and cancer.

Needs. One of the greatest needs in rehabilitation research lies in the area of heart disease, cancer, and stroke. Researchers need adequate support of doctoral and postdoctoral studies on such significant problems as effect rehabilitation of exhospital patients and modifications of patients' life patterns through training, counseling, or work therapy, and epidemiological studies including psychosocial factors relating to vocational adjustment. Research is also needed

in the psychological relationships of the cancer patient and his family during rehabilitation. Still another need is for studies of the effects of prolonged exercise on subjects with hemiplegia to determine metabolic and cardio-vascular requirements for stroke victims at work.

Proposed 1967 program.—In 1967, 39 regular research fellowships are requested at an estimated cost of $160,000, the same as in 1966. For research training in heart disease, cancer, and stroke, 120 fellowships totaling $600,000 are requested, an increase of 20 and $100,000 over 1966.

ACTIVITY III. SPECIAL CENTER PROGRAM

The 1967 request for rehabilitation research and training center program is for $8,575,000, which is an increase of $1 million over the $7,757,000 appropriated for fiscal year 1966. The $8,575,000 may be divided as follows: Five full medical centers, $5,225,000; five developmental centers, $1,950,000; three mental retardation centers, $750,000; three vocational rehabilitation centers, $550,000; and one center for the deaf, $100,000. This provides only for the continuation of the 17 research and training centers operating in 1966.

A National Conference on the Medical Rehabilitation Research and Training Centers was held on July 8-9, 1965, at Brainerd, Minn. This conference revealed the steady progress that is being made both in research and training. The older, well-established centers which have been operating 3 to 5 years are continuing to expand and develop their programs in research and their horizons of training of professional workers in all fields of vocational rehabilitation. The newer developmental centers are moving progressively toward the development of strong departments of physical medicine with broad interaction with the medical school as a whole and with a wide variety of nonmedical but related programs within the university. The more significant findings are delineated below.

TRAINING

The five established research and training centers (medical) with welldeveloped programs of research, offer didactic and clinical teaching for undergraduate and graduate students from the disciplines (medical specialists in physical medicine, orthopedic, etc., physical and occupational therapy, social work, psychologists, etc.) that regularly make a contribution to any phase of the rehabilitation process. During the past year these centers conducted special courses and institutes in the application of a wide variety of rehabilitation problems which were attended by large numbers from these disciplines as well as by 38 hospital aids and orderlies, 40 licensed practical nursing students and their instructors, 16 dietary interns, 28 community welfare workers, 22 volunteers in physical recreation programs, 15 education coordinators, 13 wheelchair manufacturers, 20 executives of rehabilitation facilities, 2 hospital administrators and 325 physicians in general practices. The total figures substantiate the decision to establish centers at universities where the faculty is capable of conducting comprehensive training programs.

The unique training emphasis of the research and training centers is indicated by the opportunity provided undergraduate and graduate students to take part in research. This supervised participation varies in scope from data collection or summarization to designing or conducting a complete project, depending upon the preparation and capabilities of the student. During the year just reported, 912 students were given research experience as a part of their training.

Three of the five developmental research and training centers (medical) have training programs of sufficient duration and scope that they are now offering internships to 201 undergraduate and 154 graduate students of 11 different disciplines, some of whom are engaged in ongoing research. The addition of needed staff and equipment financed by these grants will extend this kind of experience to many more. To date, the other two developmental centers have only been able to demonstrate team operation in a medical setting. Their augmented staff is organizing programs to training other rehabilitation disciplines and developing programmatic research.

The systematic research planned by the two mental retardation research and training centers has a strong behavioral science emphasis, and the related training in these centers is focused at present on effective counseling, training, and placement of the retarded individual. This is reflected in the attendance of 360 teachers, educational counselors, social workers, rehabilitation counselors, and placement personnel from State VR and special education agencies, public and

private residential facilities and other community settings, who took part in the thirteen 4-week institutes conducted this spring and summer at one of the centers. The other center anticipates an enrollment of 400 similar personnel at short-term workshops during this grant year. Three graduate students were engaged in research and teaching apprenticeships when these grants were initiated. The beginning of the academic year will see many more such internships in progress as both universities have a record of research contributions to mental retardation. A sizable proportion of the universities' academic schools or departments have been represented in the training program and many of their faculty and students are now collaborating in research and training in mental retardation. Two research and training centers were established this year in vocational training settings where more than 800 persons in the process of rehabilitation are being trained for employment. Represented in this population are the mentally retarded, the emotionally disturbed, the disabled or health impaired, the visually handicapped and the deaf. Some present a combination of handicapping conditions. Graduate student internships for physical therapists, rehabilitation counselors and social workers are in progress. Short- and long-term educational programs are conducted for high school and college teachers and counselors, teacher aids, educational research and administrative personnel, vocational instructors from high school and residential facilities, counselors, and other personnel from State VR and agencies for the blind.

RESEARCH

Among the more significant contributions made to the advancement of the rehabilitation process provided by the rehabilitation research and training centers are:

(a) The provision of opportunity for programmatic research not ordinarily possible in project research: Large scale attacks are being made upon such major problems as:

(1) Effective evaluation of work capacity and work tolerance in the cardiac and the stroke patient;

(2) The establishment of stable systems in the quadriplegic patient whose only hope of gaining necessary control of himself before attempting to establish his ability to carry on effective vocational adaptation;

(3) The development of devices for the patient with upper and lower extremities who, because of neurological or neuromuscular disease or accident is unable to use these essential organs of mobility for activities of daily living or the attainment of successful work performance;

(4) The determination and control of social, psychological, and vocational factors which positively and/or negatively influence the adaptation of the seriously disabled to work and to basic social living.

These are only a few significant samples of research that call for a variety of studies.

(b) The establishment of coordinated data gathering and data treatment leading to the formulation of soundly based theories of cause and effect, treatment and ultimate restoration of the chronically ill and severely disabled to their optimal levels of work tolerance and performance and to family and community living. Because of the greater vista presented in programmatic research, the results attained may often lead to a more effective and far-reaching concept of the rehabilitation process than project research may offer. We may, therefore, expect the teaching of rehabilitation theory and practice to be significantly advanced in an environment where such an approach to knowledge is prevalent. (c) The evaluation of a close working relationship between the researcher and teacher leads to a more comprehensive appreciation of both the problems and solutions by the trainee in a research and training center environment. The physicians and his associates training in this situation become sensitive to the unmet needs of the rehabilitant and gain experience in finding improved ways of meeting these needs.

(d) The research and training center provides the opportunity for financial support of patients and/or clients who participate in the research studies carried on under the grant. This insures the grantee of adequate numbers of selected patients and/or clients to meet the needs of his experimental design while, at the same time, assuring his subjects of excellent rehabilitation care and services. This process makes it possible to carry on research that otherwise might not be possible when funds for bed space and patient care or for clinical services cannot be readily obtained. This is an especially valuable feature in studies

involving participants who may not be considered eligible or feasible for support under the State agency for vocational rehabilitation.

SUMMARY OF RESEARCH FINDINGS

The amount and extent of the research emanating from the research and training centers is considerable. Some indication of the scope of this program may be found in a few brief references under several categories of investigations currently being carried out in the medical centers.

A. Medical engineering, biophysics, electrodiagnosis, and adaptive devices Under this a number of significant studies are progressing all of which are of fundamental importance to vocational rehabilitation:

(1) Studies on the rheumatoid hand and the role of exercise of the affected part in the production or reduction of rheumatoid hand deformity.

(2) The development of new bioengineering devices such as the electrophysiological splint for the disabled hand.

(3) Studies on the development of substitutive and assistive devices to aid the amputee to replace mechanically and with effective control the function of parts that have been lost. Other devices that help the victims of stroke, poliomyelitis, paraplegics, and others to regain effective use of extremities unable to operate through the normal neuromuscular channels. B. Specific disability studies

Neuromuscular and muscular disease: Development of quantitative evaluation of the electromyogram in primary muscle disease (polymyositis, muscular dystrophy, etc.).

Cardiac and cardiovascular disease: Study of the cardiac demands of vocational activities through use of the impedance cardiometer, an instrument that requires minimal disturbance of the patient and permits measurement while he is engaged in work activities; studies on the work tolerance of patients with myocardial infarction (damage to the heart muscle); establishment of the safety limits of work during therapeutic exercise for the cardiac patient; study of psychological factors and speech restoration in the patient with a cerebrovascular accident (stroke) to aid in finding effective ways of helping the stroke victim learn how to speak (when aphasic) and to gain mobility in moving from bed to wheelchair and back.

C. Disease and trauma of the spinal cord

Spinal cord injury studies include investigation of altered metabolism associated with early ambulation of the quadriplegic patient undergoing different forms of neurosurgical therapy; use of the standing bed while patient is in cervical traction, and studies on "cardiovascular deconditioning" in the quadriplegic patient.

D. Psychosocial problems of individuals undergoing rehabilitation

The development of predictive clues, measures, and devices that will aid in determining the likelihood of success of the client in the relationship process is being steadfastly pursued; evaluation of rehabilitation procedures including speech therapy, stimulation of motivation, etc., on the aphasic patient with stroke; the visual-spatial perception in such individuals as a factor effecting rehabilitation outcome; the effect of personality factors including attitudes to determine how these effect successful rehabilitation; the learning problem of the brain damaged including the stroke patient and others with organic brain damage. Such devices as automated teaching machines, methods of presenting materials to be learned, etc., are being reviewed to learn which techniques are most effective. The impact of treatment staff including nurses' attendants, and other patients.

These studies represent the breadth and strength of this program. They by no manner or means supply a complete or an exhaustive list of the many individual studies that are "getting the answers" to key rehabilitation problems.

RELATIONSHIP WITH STATE VOCATIONAL REHABILITATION AGENCY

A universal requirement in all rehabilitation research and training centers is an effective cooperative relationship with the State agency in which the center operates. This insures opportunity to provide services for the State agency clientele whenever the research program provides a need for patients. That this has been effective is shown by the examples given below.

UNIVERSITY OF WASHINGTON

Relationships with the State vocational rehabilitation agency continue to be excellent and the research and training center is providing many services to the State agency and the region. For example, the center provides seminars and individual discussion groups arranged through the district offices of the State agency. The Alaska Division of Vocational Rehabilitation has been assisted by the center staff in the development of a vocational testing program. In this research and training center a patient with vocational rehabilitation potential is brought to the attention of the appropriate State division of vocational rehabilitation through the vocational counseling unit and the State division of vocational rehabilitation assumes the responsibility of foreclosing all such cases. Conversely, patients are referred by the division of vocational rehabilitation, primarily Washington, Alaska, and Montana for prevocational evaluation and treatment. The report on patients served in 1964 shows a total of 143 were clients of the State agency. None of these patients had been closed at the time of the report.

BAYLOR UNIVERSITY

Baylor served 183 patients during fiscal year 1965 (Mar. 1, 1964-Feb. 28, 1965), of whom 53 were charged to the research and training center grant. Because of the severity of the disabilities involved, stay of these patients were 19 days. Fifty-one of the patients were discharged, of whom 30 were clients of the State division of vocational rehabilitation. This center, with its emphasis on quadriplegic, hemiplegic, and cardiac patients is doing a quite remarkable job both in servicing and rehabilitating a clinical type of patient who, in the past, has been neglected or inadequately served.