Rehabilitation Engineering

Summary

Rehabilitation (or rehabilitative) engineering is the application of engineering sciences to improve the capabilities and quality of life for people with physical and cognitive impairments. Functional areas addressed through rehabilitation engineering may include the development of devices not only to enhance mobility but also to improve communication, hearing, and vision. Rehabilitation engineering, which is considered a subset of bioengineering, becomes an important aspect of returning to employment, independent living, and integration into the community for many individuals. Rehabilitation engineers design prosthetic devices and seating and positioning technologies, or plan modifications of homes, workplaces, and vehicles for the disabled.

Definition and Basic Principles

Rehabilitation engineering applies the techniques of engineering to improve the quality of life of people with disabilities. Disabilities are of varying severities and often affect functional capability, such as mobility, communication, hearing, vision, and cognition. Such functional impairments can affect a person's participation in activities associated with employment, independent living, and recreation. Rehabilitation engineering examines the nature and involvement of disabilities so that an appropriate medical device such as a prosthetic limb or component of a knee replacement can be designed. After engineers gain an understanding of a particular injury or disability, they develop a device that is tested, evaluated, and adapted as necessary. Engineers work with other medical professionals in the design and development of rehabilitation devices such as physical, occupational, and speech therapists, scientists, physicians, special education teachers, and industrial designers.

Background and History

Rehabilitation engineering originated in the United States shortly after World War II when the National Research Council established a committee on prosthetic devices. The council brought together physicians, surgeons, and allied health professionals who were involved in medical engineering research. In 1954, an increased awareness of the need to combine engineering with rehabilitation led to the passage of important amendments to the Vocational Rehabilitation Act, authorizing the funding of research and development. Between 1960 and 1970, the number of rehabilitation research facilities grew, and the size and stature of the medical specialty of physical medicine increased. James Garrett, chief of research and development at the Social and Rehabilitation Service, coined the term “rehabilitation engineering” around 1970. In 1971, several rehabilitation engineering centers were established with federal government funding. The Rehabilitation Act of 1973 ensured that these centers would continue, and as of 2022, there were twenty rehabilitation engineering research centers funded by the National Center for the Dissemination of Disability Research.

How It Works

Rehabilitation engineering improves the quality of life for people with disabilities by taking a total approach to rehabilitation. Medical professionals such as physicians and physical, occupational, and speech therapists study and treat problems confronted by those with physical, functional, and communication disabilities, and they rely on equipment and devices to treat their patients. Whether used in an acute hospital setting or in an outpatient clinic specializing in sports medicine, the equipment and devices used in rehabilitation are a collaborative effort by engineers and medical professionals such as physical therapists. For example, physical and occupational therapy relies on equipment and devices in the treatment of patients recovering from loss of motion, strength, and balance and overall mobility. Engineers work with medical professionals to develop the type of equipment that will help the patient recover and gain increased ability to perform the activities of daily living. For example, researchers from engineering and physical and occupational therapy can determine how propelling a wheelchair relates to upper-extremity pain in individuals who have traumatic spinal cord injures or multiple sclerosis.

Biomechanics laboratories are important sites where rehabilitation engineers, rehabilitation professionals, and medical device industry representatives can work together. In these laboratories, new products and techniques pass through all research and development phases and eventually reach the patient. Through clinical experience and research, rehabilitation professionals (and sometimes patients) identify a specific rehabilitation problem. Researchers develop a possible solution, which may include the need for a medical device such as a specific knee brace or an artificial arm with computer sensors. Rehabilitation engineers begin by developing a product concept and design. In the initial design phase, they may use electronic tools to create an abstract form of the product. Once the initial design phase is completed, a limited number of physical prototypes of the rehabilitation device (such as knee brace or strengthening equipment) are created and used to prove that the initial design is practical, effective, and safe. During this phase, it is common for the engineering team to develop the product by hand. If the rehabilitation device is satisfactory, the production phase begins, and the original design concept becomes reality.

Applications and Products

Devices and Technology. Healthcare professionals who work directly with individuals with physical, functional, and communication disabilities provide vital information to rehabilitation engineers on what type of devices are needed to compensate for what type and degree of disability. Engineers work to develop equipment best suited not only for assisting in the patient's initial recovery but also for facilitating activities of daily living. Strength training equipment, for example, has seen advancements in computer-assisted machines that can maintain constant torque or tension as muscles shorten or lengthen. This technique, called isokinetic strengthening, can make rehabilitation more efficient by allowing the therapist to take a more specific approach for their patient.

A collaboration of biomechanics, bioengineering, and physical therapy in the late twentieth century led to significant advances in the development of prosthetic devices. The fabrication of robotic prosthetic hands that can use remaining muscles to reproduce all the motions of the human hand and fingers is just one example. The development of assistive devices to address a loss or lack of mobility can significantly improve the quality of life for individuals with disabilities. Physical therapists assist engineers in producing adaptive equipment such as specialized wheelchairs, walkers, and canes as well as rehabilitation equipment for enhancing strength, range of motion, and balance.

Occupational Therapy. Occupational therapists are trained in the structure and function of the human body and the effects of illness and injury. They can recommend or develop devices to help avoid injury or illness at home or on the job. They also help people with physical or cognitive limitations return to work or relearn activities with the help of assistive devices, if necessary. Occupational therapists and rehabilitation engineers often collaborate to determine how components of the workplace (such as a specific tool in an assembly line or a computer station) can be adapted to produce a functional and efficient environment. For example, an occupational therapist may work with a rehabilitation engineer to develop a hand and wrist brace to be used by workers who engage in repetitive movements or to modify tools and equipment so that injury or illness can be avoided. Therapists and engineers can collaborate to find better working conditions for employees who must maintain a fixed or awkward posture for extended periods of time. They also produce adaptive equipment (such as seating and mobility aids) for children and adults with disabilities. Generally, rehabilitation engineering and occupational medicine work together to examine the complex physical relationships among people, equipment, job duties, and work methods.

Speech Therapy. Rehabilitation engineers work closely with speech therapists, who deal with people who have difficulty with speech, communication, fluency, and swallowing. Speech therapists initially try to maximize a person's existing speech capabilities, whether the individual's problems result from a congenital disorder, an illness, or an injury. If normal communication cannot be achieved, assistive devices can be used for speech and hearing. Nonverbal patients or those with severe impairment of speech functions typically need alternative methods of communication. At this point, rehabilitation engineers become involved, whether directly or indirectly, through the evaluation and development of electronic augmentative communication devices.

A wide range of communication needs can be met with augmentative communication systems, most of which are designed to be portable. For example, words and messages stored within the memory of a small computer can be accessed by a user and conveyed through a synthesized voice. ZYGO Industries' LightWRITER is a portable text-to-speech communication aid with two displays, one that faces the user and a second that faces the other person, allowing audible communication in a natural face-to-face position. Multicomponent communication systems consisting of a collection of techniques, aids, symbols, and strategies also have been designed and developed.

Audiology. Audiologists evaluate and develop solutions for people with hearing loss. Rehabilitation engineers work closely with audiologists to design hearing aids and related devices. The design and application of each device depends on the nature of the individual's auditory disorder, and professionals must be familiar not only with the design of the hearing device but also with its operation as some units are programmable, digital, and able to measure performance.

Rehabilitation engineering is active in the research, design, and development of devices used in phoniatrics, a subfield of audiology that studies communication disorders and tries to determine their causes. For example, rehabilitation engineers were involved in the research and development of cochlear implants, a surgical implant that enables individuals with certain hearing disorders to hear speech and everyday sounds. Postsurgical care often includes intensive therapy from a multidisciplinary medical team to help patients fully develop their speaking and comprehension skills.

Careers and Course Work

Rehabilitation engineering offers careers for not only engineers but also physicians, physician assistants, laboratory technicians, statisticians, and supporting research laboratory personnel. A career in rehabilitation engineering can be rewarding and stimulating because technology in this area is ever-advancing. Biomedical and rehabilitation engineers are employed in industry settings, such as medical equipment and supplies as well as scientific research and development services. They can also be employed at hospitals and research facilities of medical institutions and universities. Rehabilitation and biomedical engineering positions in government agencies can involve product testing and developing safety standards for specific devices. Some biomedical and rehabilitation engineers are consultants for marketing departments of medical device companies, and others are employed in management positions.

High school students who are interested in biomedical and rehabilitation engineering as a career should focus on taking courses in biology, chemistry, physics, and mathematics. Courses in cellular biology, human anatomy, and biochemistry are also helpful, if available. Students planning on entering the field typically obtain a degree in engineering, then choose a discipline within engineering, such as biomedical engineering, and later specialize further in rehabilitation engineering. A master's or doctoral degree is required for a position with most research and development programs but not for the majority of entry-level rehabilitation engineering jobs.

Professional organizations and associations offer a wide range of resources for planning a career in rehabilitation engineering. They can help students determine the proper course work and keep them abreast of trends in the industry. Associations promote the interests of their members and provide a network of contacts that assists in finding jobs. They can also offer a variety of services, including job referral, continuing education courses, insurance, and travel benefits, and often publish periodicals and hold meetings and conferences. Associations serving biomedical and rehabilitation engineers include the American Institute for Medical and Biological Engineering and the American Society of Mechanical Engineers, Bioengineering Division.

Social Context and Future Prospects

According to the US Bureau of Labor Statistics, biomedical engineers (which include rehabilitation engineers) occupy about 19,700 jobs as of 2023. Biomedical engineers are expected to experience 6 percent employment growth by 2030. The median 2023 salary in the field was $100,730  per year. This rapid increase is attributed to the aging population and the focus on health issues. The demand for better medical devices and equipment designed by biomedical and rehabilitation engineers is likely to grow, and advances in rehabilitation product technology are continually being made. Rehabilitation engineers have harnessed the progress in computer technology to improve quality of life. For example, engineers are developing fully implanted and wireless systems that will detect muscle activity from electrodes implanted just under the skin or scalp. These systems mean that users will no longer have to wear detecting hardware on their heads or faces. Studies are examining whether jaw muscle contractions, detected by sensors on the scalp or just under it, can be used to activate other muscles. Ongoing research covers a range of robotics technology, including manipulator, sensor, computer vision, multimedia applications, and autonomous robots.

Bibliography

“Bioengineers and Biomedical Engineers.” U.S Bureau of Labor Statistics, www.bls.gov/ooh/architecture-and-engineering/biomedical-engineers.htm#tab-1. Accessed 6 June 2024.

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