Sec. 104, Grants to States to Initiate or Expand Services. Title II, Evaluation of Rehabilitation Potential. Sec. 410, the National Information and Resource Center for the Handicapped. Sec. 411, National Center for Deaf-Blind Youth and Adults. Sec. 412, Comprehensive Rehabilitation Centers for Deaf Youths and Adults. Sec. 413, National Commission on Transportation and Housing for the Handicapped. Agency Relationships Mr. Chairman, in my earlier remarks, I mentioned that there has been a decline of confidence in the role of the Federal government in the rehabilitation field. A major reason for this is the fact that the rehabilitation agency in government no longer formulates policy on rehabilitation nor does it administer all of the cluster of programs which the Vocational Rehabilitation Act has so wisely provided. Sec. 603 of H. R. 8395 touches upon this subject and the Committee Report accompanying the bill discusses it further. The Rehabilitation Services Administration has existed as a bureau of the Social and Rehabilitation Service in the Department of Health, Education and Welfare for nearly five years. During that time, the effectiveness of the agency has diminished steadily, despite an informed and hard-working staff. Those of us outside government, who are accustomed to working with a live and vital rehabilitation agency, have been disappointed and discouraged as we watched this process take place. - 9 We are not sure what the remedy is but we hope that you and the committee will give serious attention to this organizational and administrative problem which, at present, threatens the success of any new legislation that is enacted. Mr. Chairman, we deeply appreciate what you are doing to develop an improved law for the rehabilitation of the nation's disabled people. Please be assured that the American Congress of Rehabilitation Medicine will assist you in any way possible. Senator CRANSTON. Thank you very much, Dr. Lowman. STATEMENT OF DR. HOWARD RUSK, DIRECTOR, INSTITUTE FOR REHABILITATION MEDICINE Dr. RUSK. My name is Howard Rusk and I am director of the Institute of Rehabilitation Medicine at New York University. I asked myself to have an invitation to come and to discuss with you briefly and personally some of the tremendous advances that I have seen made in rehabilitation in the last, well, since I started to be interested in working in the program more than 25 years ago, and some of the most exciting things that are well off the drawing board. I think that we are in the most hopeful era of programs for disabled people now than we have ever been in history. I don't think industry has ever had the understanding that they have today on hiring disabled people and I don't think the climate with labor has ever been as good as it is now. Their participation is evidenced by a national convention every year, a training seminar that lasts for more than a week, in which labor people come from all over the country. I don't think the climate has ever been as good internationally as it is now, and what we feel that we need, as my colleague, Dr. Lowman, has outlined, is some tightening of the legislation, funds, obviously, and the number of trained people that we need to do the job. Now, I am not going to talk any more in the broad field. I want to tell you about some actual things that have happened recently in the program. In World War I there were 400 paraplegics as a result of combat. There were no problems then. One-third died before they got out of France. One-third died within 6 weeks after they got back to this country and the remaining third, 90 percent, were dead in the first year. In World War II we had 2,500 paraplegics as a result of combat and this time they didn't die, because of antibiotics and better surgical techniques, better knowledge of nutrition, and they were young men and had given their bodies to their country and they wanted to live the best lives they could with what they had left. Of the original 2,500, remembering there was no program in the Veterans' Administration at all for this kind of patient in 1945 at the war's end-and it all had to be started from scratch and staffed from scratch-but of the original 2,500 the last figures that I had from Veterans' Administration, that just under 1,800 were living in their own homes, driving their own cars and 1,400 of that group were at work in competitive industry. So we learned a great lesson when we began to be proud of this because we found the caseload didn't go down at all. For every veteran paraplegic that was rehabilitated, one and a half patients came in from civilian life with paraplegia as a result not only primarily from injury but some from disease. I would like to say a word of compliment for the Veterans' Administration, the way their spinal cord injury program has developed, and especially with the help of the chairman today, I think that this has been recognized, and I don't think enough yet fundwise has come about to let them increase their program to meet the needs of severely disabled Vietnam veterans, which are the most severely disabled we have ever had, because in this whole field we are in a very difficult position. Every time we make a medical advance as far as we are concerned you compound the felony. Because you keep people older long, to get all the disability that come about with an aging population, we save the lives of very severely injured and disabled people and they require new techniques and training. Let me give you the results of a study that we have recently made in our own institution. We have become sort of a center, not for paraplegics, but for quadriplegics. These individuals with broken necks, young people, paralyzed from the upper chest down-no sensationbowel and bladder paralyzed, ends completely paralyzed or partially paralyzed, depending on the level of the legs. And if I had testified before this committee-if this were 15 years ago and asked me you the question, what can you expect with results with this type of patient, I would have said, if you got 10 percent back in on some kind of life it was reasonably good. Four years ago we did a retrospective study on 141 youngsters with broken necks with an average age of 20, as to what they were now doing. Fifty-three percent were either back in school or at work in competitive industry. Last year we did a second retrospective study of 141 youngsters with broken necks as to what they were now doing and 83 percent were back at school or at some kind of gainful work. This has been very heartening to us and I was asked a question last month by an interested person in the program: how long does it take and how much does it cost to rehabilitate a quadriplegic? Well, it takes us an average of about from 6 to 8 months and the average cost I would say is something around $40,000 a case. They said, how in the world can you spend that much money on one patient? And my reply was, we spend that much because we can't afford not to, and they asked, what did I mean? I said the average age of our young quads in the institute is 20 years. Now, we know, and have so testified legally on many occasions, that if they follow the programs that they have learned in the institute to take care of their kidneys and bladder needs, skin and nutrition, that their expectancy is within 2 years of the normal. So these young people with an average of 20 have 50 years to live. If you give them nothing and send them to a continuing-care institution and give them part-time attended care, if you can do it in the New York area for $15,000 a year, it is a bargain. The arithmetic is easy. Fifty years times $15,000 a year is three quarters of a million dollars per case. And if you want to go into the actuality of it, use the compound interest, and see what that means, it goes up into the millions, leaving the most important factor out of it, and that is the individual. That is the reason that I said we can't afford not to. This goes back to some of the original figures that you all remember, that Miss Switzer used through the years after the studies she made, and one reason that the Congress came into the whole support behind this program and the increased moneys available 10 times in 10 years was that she was able to show that for every dollar spent in rehabilitating the individual, that $5 came back in Federal income tax the first 5 years. That 90 percent of these individuals were not em ployable private training and 90 percent were employable—were employed after training. So we are heartened about this. Talking about paraplegics, our average training time for a paraaplegic is 120 days and we place 95 percent in competitive industry with no trouble at all for a simple reason that you may have forgotten, as many of us have forgotten, and that is, our society today does not pay for strength. It only pays for two things the skill in your hands and what you have in your head. And physical wholeness and ability are not synonymous and there can be an advantage to disadvantage. If you put one of our paraplegics in a chair on a bench job requiring upper arm strength and hand skills, he will kill the ordinary worker productionwise because he is working with tremendously hypertrophied muscles with which he walks. There have been at least 30 surveys made in the last 20-odd years as to the performance of the disabled in industry, and everyone has shown properly the same thing. And that is, that properly trained and placed-I repeat this properly placed and trained, the disabled have a better production rate, lower accident rate, lower absentee rate, and an average of nine times less labor turnover than the normal, working side by side with them. That's the secret in providing rehabilitation training and services. I am delighted at the interest in establishing spinal cord injury centers throughout the country, both for service and for research and it has been extremely interesting and exciting to me to see that the National Institutes of Health have gotten deeply interested in the research side, and the program is now developing so there would be a dual program for service, early service, transportation, rehabilitation, and along with that there will be continuing research, both clinical and basic. I will say that there are some very exciting straws in the wind, at least, that is, in some of the findings in early refrigeration of patients with spinal cord injuries to prevent swelling. There are also some new and unreported, but exciting leads in certain chemical changes, especially in the enzyme system, if it can be controlled early, it will increase the opportunity for healing and for return of function very markedly. I am also delighted to see the increasing interest in the Congress and the RSA in rehabilitation engineering. I might say, I was in on the beginning of the research in prosthetics when we had a problem in the Air Force. At that time I was director of the program and General Arnold made a personal and very strong appeal and then a point that we had to have research in prosthetics, and the Congress within 6 weeks after the question came set up the National Prosthetics Committee program with a million dollars for the first research which has been responsible for the development of the fine prosthesis that we have through the years. Last month we had the most exciting experience at the Institute. We learned of a program in Italy, funded by the Social Security Department of the Italian Government, outside of Bologna, in which he has really developed a practical myeloelectric hand. The hand is over here, over here, and even the shoulder. This hand is made of a special type of plastic. An electronic device is within the prosthesis |