Howard A. Rusk

A new approach to the objective evaluation of physical disability

MUCH has been said in the last decade of the outstanding advances of medicine and surgery, and, as a direct result, of the prolongation of life. Persons with formerly fatal congenital deformities, disease, or injury, were saved. So also were those suffering from acute infections kept alive. Further, the fact that people lived longer meant more people were reaching the age group where the chronic degenerative and disabling conditions were prevalent. Concomitant with these developments was the enormous expansion of industry, spurred by the war and the development of new technological processes. The result of expanded and more complex industrial processes together with the advances in medicine has been a great rise in the number of chronically ill and disabled persons as well as a large addition to this number yearly. Thus, every physician and especially those in contact with industrial medicine, sooner or later must concern himself with disability evaluation. That proper evaluation represents a problem of major proportions is attested to by the fact that the Journal of the American Medical Association has recently begun to publish a series of guides to the determination of medical impairment [l]. Disability is differentiated from impairment by the fact that “disability” includes socio-economic factors in addition to the purely medical. Many types of schedule have been devised to permit evaluation of disability but these have all been based on anatomic loss alone, probably due to the difficulty of measuring socio-economic factors. Although the physician is not responsible for determinations in the socio-economic areas, he is often a member of a team where these considerations are raised. The rising tide of disability has to a great degree been responsible for legislation in the fields of vocational rehabilitation, social security, workmen’s compensation, etc. However, these attempts to handle the problem have only been partially successful because similar cases might be judged totally disabled in one state, partially in another, or not at all, from a vocational point of view, in a third.

The Effect of Hyperbaric Oxygen on the Mental and Verbal Ability of Stroke Patients

Based upon the assumption that oxygen under increased atmospheric pressure (OHP) might improve the verbal and mental function of patients who had suffered vascular infarcts, 32 stroke patients were exposed to such an ambient atmosphere and tested under controlled conditions. The results make it clear that a single exposure to 100% oxygen under two atmospheres of pressure, which is productive of high blood oxygen levels, does not improve the communication and cognitive-perceptual function of these patients.

The foreign medical resident training in the United States.

Abstract Fifty foreign and 50 U. S. internal medicime residents from medical school-affiliated teaching hospitals were randomly selected for participation in this investigation. Information was eli...

THE RELATION OF PHYSICAL ACTIVITY AND OCCUPATION TO CORONARY ARTERY HEART DISEASE

Excerpt INTRODUCTION It has been suggested that there has been an increased incidence of coronary artery heart disease in recent years. This disease of modern civilization has assumed prominence du...

Rehabilitation of Patients With Obstructive Pulmonary Diseases: The Role of Enriched Oxygen

The conclusion may be drawn that rehabilitative measures for obstructive pulmonary diseases are better tolerated in an oxygen-enriched atmosphere. No ill effects have been observed. An increase of 4 to 10 per cent in the oxygen concentration of the atmosphere appears to be sufficient to maintain approximately normal arterial oxygen saturation.

Bracing and rehabilitation training. Effect on the energy expenditure of the elderly hemiplegic; preliminary report.

Rehabilitation training and brace wearing resulted in considerable conservation of energy in 10 elderly hemiplegic patients, the former therapeutic modality playing a larger role in this conservation than the latter. Total energy expenditure at the conclusion of treatment was still 31 per cent higher than that of the reference group. In spite of this additional energy demand, cardiovascular complications were not observed in the course of the therapeutic program. This suggests that elderly hemiplegic patients possess sufficient reserves to be able to cope with the increased physical demands of a rehabilitation program.

Army Air Forces Convalescent Training Program

W E ARE having an opportunity in the armed forces to carry out one of the greatest clinical studies ever attempted in rehabilitation and convalescent care. Our total numbers of cases have run into the thousands, our controls have been reasonably constant, our opportunities for clinical observation have been unlimited, and our results have been most interesting. They have shown us that any program designed to give the patient maximum treatment and opportunity to return to civilian life as a self-respecting, selfsustaining citizen with a community contribution to make, must, to be successful: (1) treat the whole man, regardless of what his needs may be; (2) treat the patient as an individual; and (3) be early, continuous, and progressive from the earliest possible moment following acute illness or injury until maximum possible benefits have been received. It is upon these premises that the Army Air Forces has built its plan for the treatment and management of its sick and wounded.

Rehabilitation of the hemiplegic.

Unfortunately, in the past, the medical attitude toward hemiplegia has been one of hopelessness and helplessness. If a dynamic approach is used, however, the hemiplegic is not a lost cause. Spot checks have shown that 90 per cent can be taught ambulation, self-care and urinary and fetal continence, and 40 per cent can be taught to do gainful work.

Keeping Older People Fit for Participation

death rates is the tremendous long-term toll of chronic illness and disability. Acute infectious disease usually results in rapid recovery or death, but chronic illness may linger for years. Its social and economic costs cannot be measured by mortality tables alone. As our population becomes older, it can be expected that the prevalence of chronic disease and its resultant physical disability will increase correspondingly ; studies indicate that the higher the age group, the greater the percentage of chronic disease and disability. The National Health Survey of 1935-36 showed the following numbers of per-, sons with a chronic disease or impair-

New Resources for Rehabilitation and Health

During the past few years many new resources have been created to improve the health and welfare of all the people of the world. These new resources include international governmental organizations such as the World Health Organi zation, United Nations, International Labour Organisation, and the United Nations Childrens Fund (UNICEF). Interna tional voluntary organizations, multilateral and bilateral, are setting new standards. Increased educational opportunities and the development of professional associations are other impor tant new resources. The realization by most of the people of the world that better health, rehabilitation, and welfare services are possible and the demand for such services are also to be regarded as new resources. Most important is the changing attitudes of individuals and communities toward physical handicaps and illness. These new attitudes are the primary new resource for future work in the health and welfare field.