Resistive Exercises in Physical Therapy for Thoracoplasty: This film showing physical therapy techniques to offset deformity after thoracic surgery reflects important advances made by the Veterans' Administration through a specialized exercise program. It is used widely in teaching centers, hospitals, clinics, and training programs. This technique has attained international use and recognition.

You Can Hear Again: This motion picture depicts in a realistic manner the patient's recognition and conquest of defective hearing with the aid of the Veterans' Administration aural rehabilitation program. It has been used extensively by both professional and lay groups as an orientation to an improved concept of this problem and has been televised on the major networks of this country.

Hydrotherapy Procedures for Neuropsychiatric Patients: This training guide for the instruction of VA physical therapy aides presents an improved method of hydrotherapy procedure for the psychiatric patient. It is used extensively in the training of hydrotherapy aides in the Veterans' Administration, and other Federal and State agencies.

Articulation of English Speech Sounds: This film was prepared through the cooperation of a patient of the Veterans' Administration who suffered extensive loss of the structures of the head as a result of a malignancy. For the first time direct photography was used to illustrate the movements of the laryngeal and articulatory structures in the production of oral continuant consonants, nazal continuants, plosives, and affricatives commonly present in general American speech. A second section of this film illustrates production of vowels and dipthongs. This film is a most important contribution to the training of speech therapists who are providing therapy designed to rehabilitate veterans with articulatory speech disorders and is being used extensively as a teaching aid.

14. SCOPE OF PHYSICAL MEDICINE AND REHABILITATION PROGRAM

The chart below indicates that 120,283 different patients at 206 field stations received one or more physical medicine and rehabilitation therapies during the 3-month period November 1953 through January 1954. In relation to the numbers of patients treated in the first quarter of the year, there is an increase of more than 5,000 which indicates that proportionately this service is being called upon to treat more patients than previously. It appears that this trend will continue, in view of known factors respecting chronicity of patient illness. The number of personnel on duty in January 1954 was 3,758 in all categories of physical medicine and rehabilitation.

Domiciliaries.

15. CLINICAL TRAINING PROGRAMS, IN PHYSICAL MEDICINE AND REHABILITATION There presently are six active clinical-training programs in specialties of the Physical Medicine and Rehabilitation Service carried on through the Education Service, Research, and Education, Veterans' Administration. These programs include student trainees in the following therapy specialties: Physical therapy, occupational therapy, corrective therapy, educational therapy, and manual arts therapy.

A training program is also in effect for executive assistant, Physical Medicine and Rehabilitation.

The objectives of these programs are: To provide training broad in scope and high in professional quality; to maintain educational standards directed toward improving the care and treatment of patients; and, on completion of the student's professional training, to provide a source of professionally qualified personnel for the VA Physical Medicine and Rehabilitation Service.

The following information is offered as pertinent to these programs: (a) Physical therapy-23 physical therapy schools, approved by the American Medical Association, are currently affiliated with the Veterans' Administration. Thirty-two VA field stations are included in these affiliations. During the school year 1952-53, 307 students participated in this training program. Since its inception in December 1947, this program has provided the VA a valuable source of personnel available for employment.

(b) Occupational therapy-24 universities, colleges, and schools offering courses in occupational therapy, approved by the American Medical Association, are currently affiliated with the Veterans' Administration. Sixteen VA hospitals are presently designated as training centers for students from the affiliating schools. During the school year 1953-54, 218 students will participate in this training program. It may be pointed out that since January 1948, when this program was instituted, 33 percent of all the students that have received training in the VA have accepted appointments in the agency.

(c) Corrective therapy-Three universities and colleges, offering specialized training to prepare physical-education students for work in rehabilitation are now affiliated with the Veterans' Administration. There are also two additional universities who will affiliate in the near future. Four VA hospitals are presently designated as training centers and 4 additional will be designated when the 2 universities become affiliated. This program has only been in effect since January 1952 but it has already provided an excellent source of recruitment for the VA; 23 students completed training during school year 1952-53 and 14 of these students accepted employment with the agency.

(d) Manual arts therapy-At the present time there is one college offering an industrial arts course which has been approved for affiliation with a VA hospital for clinical training. Three other colleges or universities are now being considered for similar affiliation. At least three additional VA hospitals will be needed as training centers when these programs have been developed and approved. Since the program was initiated in January 1953, 14 students have participated in this training but will not have completed their undergraduate studies until either June 1954 or June 1955. A significant number of these students have indicated a desire to accept VA employment in this specialty.

(e) Educational therapy-In September 1953 one university introduced a graduate course of study in educational services in rehabilitation. The first students to complete the curriculum should graduate in 1955, and at that time an affiliation will be established with a VA hospital for clinical training. Two other universities or colleges have indicated their interest in establishing corresponding programs, and when developed, similar affiliations will be approved. The graduates will provide an excellent recruitment source for educational therapists in the Veterans' Administration.

(f) Executive assistant-One university instituted a graduate course of study in executive services in rehabilitation in September 1953. An affiliation has been established with two VA hospitals for students to receive training for the executive assistant position. Arrangements for similar courses of training and affiliation are now in process.

The importance of these training programs is magnified by the acute nationwide need for rehabilitation therapy personnel, all of whom are in the critical shortage category. The VA Physical Medicine and Rehabilitation Service, the largest of its kind in the world, necessarily must provide care and treatment of the highest caliber for veteran patients, and through training of this type, facilitates recruitment of these much needed personnel for its own program.

VOCATIONAL COUNSELING IN VETERANS' ADMINISTRATION HOSPITALS

Vocational counseling (formerly known as advisement and guidance) for patients in VA hospitals was authorized in 1946 in connection with the Public Law 16 vocational rehabilitation training program. By 1949 this service had demonstrated its ability to appropriately fit into the hospitals' purpose of reestablishing for patients their occupational potential for gainful employment. Hence, it was determined to recognize rehabilitation counseling as an element of medical care, and such counseling was extended to all of those patients in the VA hospitals whose disabilities resulted in a vocational handicap, without reference to the question of whether such disabilities are, or are not, serviceconnected. It was thought that the vocational counselor working in cooperation with physicians as a member of the hospital team, coordinating his efforts with the clinical psychologist, the social worker, the psychiatrist, and the various members of the physical medicine and rehabilitation staff, could do much to reorient the patient toward future occupational planning and thereby to offset tendencies to become dependent and willing to remain hospitalized longer than necessary. The functions which were being performed with respect to vocational rehabilitation training under Public Law 16 continued to be the responsibility of the vocational counselors.

In the selection of hospitals in which the revised program was to operate, emphasis was placed upon hospitals having tubercular and neuropsychiatric bed capacity because of the known need of these categories of patients for vocational counseling.

The actual implementation of the Vocational Counseling Service began with the appointment on July 1, 1952, of a Chief, Vocational Counseling Section, in the office of the Chief, Professional Services, Department of Medicine and Surgery. The progress made in the first year of operation on the new basis may be indicated by the following letter dated August 13, 1953, over the signature of the Chief Medical Director of the Veterans' Administration:

"1. You will be interested to know that the Vocational Counseling Service program of the Department of Medicine and Surgery is developing rapidly and ahead of schedule. Sizable numbers of fully qualified professional persons have already applied and have been determined eligible on the civil-service registers for appointments to staff positions. This trend is continuing and represents recruiting possibilities in the near future beyond the early expectations. The VA program has the full and solid support of American psychology and, to a greater degree, that of the universities, on whom the VA is dependent for train- · ing of future personnel. This support already, generously given, is extremely important to all of us for it is the field of psychology which is the foundation of all the basically effective procedures in vocational counseling.

"2. A 4-year doctoral level training program has been established with the cooperation of the leading universities of the Nation. In response to my request of a year ago, the American Psychological Association has approved 17 of the major universities for offering professional training in counseling psychology. An additional number is expected to be approved during the current fiscal year. A corresponding number of suitably located VA hospitals are being designated for training units. Rotational assignments through all types of VA hospitals will provide the practical training essential to the optimal care of our patients. "3. With the increasing age and numbers of patients and with the heavier demands being made for the care of long-term patients, it is becoming ever more apparent that sound evaluation and realistic placement of patients in jobs will be a more and more important function in our hospitals. Being of service to these patients means understanding and working with them as individuals— individuals with mental and/or physical disability but also with remaining skills and abilities useful and needed in industry and in our society as a whole. Their aptitudes must be carefully explored and professionally evaluated if they are to be properly placed in productive activities which will allow them to become selfrespecting, independent, useful citizens in their home communities.

"6. The VA would be failing in its mission if it did not plan for and establish the type of program which is clearly needed for a top-quality medical program through the years to come. * * *

"8. In the interest of the veterans concerned and, in particular, those who will need care in the years to come, the support of the program by all elements of the VA is expected and has, in fact, already been demonstrated to an impressive degree."

At the present time, 117 vocational counseling personnel are on duty in 71 VA hospitals. Forty-two of these personnel are qualified under the civil-service standards for this position and others are working toward their doctorate degree in order to qualify. Under the auspices of the DM&S a program for the training of counseling psychologists was established in September 1952 with the primary purpose of supplying fully trained and professionally qualified personnel to meet this need. There are now 85 persons from 17 approved universities engaged in this training in 20 VA hospitals.

Mr. WHITTEN. I think the Veterans' Administration people basically probably agree that the way the civilian rehabilitation program is carried on is better for the individual crippled person, but they had such tremendous numbers of people to deal with that they have had to departmentalize their work in order to get some order into it, and what they have done has not been necessarily by choice, but by necessity.

Senator PURTELL. Are there any other questions?

I want to thank you very much, Mr. Whitten. You have helped us a great deal.

Mr. WHITTEN. Thank you, sir.

Senator PURTELL. Our next witness is Dr. Jacobus ten Broek, president of the National Federation of the Blind.

Senator HILL. Mr. Chairman, may I make a brief statement here? I have another committee meeting in executive session, where I must be in attendance. I am going to have to leave this session. I want to apologize to Dr. tenBroek, and also to my good friend, Dr. Edgar Fuller, but I am sure they will understand my situation. I have this other meeting in executive session, where I just must be, but I want to assure Dr. ten Broek and Dr. Fuller that I shall certainly read their testimony carefully and with much interest, and I am sure with much benefit.

Senator PURTELL. I am glad we are able to have some of your time this morning.

Senator HILL. Thank you, sir.

Senator PURTELL. I think for the record, too, I want it known that because not all of our members of the committee are present is no indication of a lack of interest. They do have other committees. They have duplications of other meetings. So, I am sure all the evidence given here this morning will be studied by all the members of the committee.

Dr. ten Broek, we will be very glad to hear from you.
Dr. TENBROEK. Thank you, Mr. Chairman.

Senator PURTELL. You have a prepared statement. Do you wish to file it and then

Dr. TENBROEK. Mr. Chairman, if I may, since I have prepared this statement with a good deal of care so as not to overstate my case or understate it, and since I am in disagreement with much that has already been said and doubtless will be said through these hearings, I would request your permission to read the salient features of this and then, thereafter, to ask you for permission to incorporate certain additional materials in the record.

Senator PURTELL. We will see that the statement you supplied us is incorporated in the record. You may read all you wish, Doctor, and add whatever you wish to it.