October 31, 2016 | October 2016 issue
October 31, 2016 | Recognizing that rehabilitation can “help people with disabilities reach their full potential,” the NIH recently published a plan for rehabilitation research to spearhead future efforts. The five-year plan was led by the National Center for Medical Rehabilitation Research, an entity of the National Institute of Child Health and Human Development.
The plan sets a roadmap to guide funding and research thrusts and gain a better comprehension of the body’s repair mechanisms. It is segmented into five areas of concentration: need, investment, current activities, opportunities, and agency coordination.
According to the CDC, approximately 53 million Americans have a disability, while over 43 million are caring for a person with a disability. While these numbers are startling, even more significant is the fact that this population experiences higher disparities within the healthcare system, as noted by the Health People 2020 Initiative published by the Department of Health and Human Services. Also, caregivers experience high levels of stress, poor health, and financial strain. The authors also recognize the obstacles that inherently exist within rehabilitation research. Challenges of transportation, finances, and mobility inhibit the recruitment of research participants, which leads to the difficulties of conducting comparison group evidence-based therapy studies.
Progress forward requires an understanding of prior rehabilitation efforts from the NIH. The NCMRR was created in 1990 with a mission to reduce “disability by conducting and supporting research and research training in medical rehabilitation.” The initial research plan established seven categories to advance the scientific study of medical rehabilitation: mobility; behavioral adaptation; whole body system response; technical devices; measurement, assessment and epidemiology; treatment evaluation; and training of research scientists. Fast forward to 2012; the NIH director assembled a blue-ribbon panel to assess the state of rehabilitation research. The panel recognized the rapid progress in areas such as basic biological mechanisms, access to outcome and care data, and new technical applications for the targeted population. There were also several recommendations for improvements. The investments made of the past two decades culminate in the current activities within rehab research.
Current activities within the NIH for medical rehabilitation research recognize the field encompasses a multidisciplinary medical team. Last year, the NIH awarded $514 million in grants and contracts to extramural rehabilitation research while tapping the NIH Common Fund for programs across several institutes and centers. Even within the agency, the research portfolio is addressing the need for new technologies, imaging, and data management. The current research is peppered with technological developments scoped within the neurotechnology industry. Specifically cited are brain-computer interfaces, smart prosthetic limbs, retinal prostheses, and robotic exoskeletons. The activities also include interactions in specific segments of the disability population such as virtual communication with people living with tetraplegia, provision of aural rehabilitation technologies, and restoration of function for spinal cord injury using electrical stimulation. Sociological thrusts are active in areas for self-management and caregiver interaction as well as gaining a better understanding rehabilitation services for persons living with disabilities. Finally, the listing of current activities warrants areas of broader discovery such as interventions for knee injuries, urinary and fecal incontinence, sexual disorders, weight-bearing exercise for diabetes, and peripheral neuropathy as well as non-pharmacological methods of pain management.
NCMRR established six primary goals for roadmap of rehabilitation research. These goals were crafted between 17 institutes and centers aligning with legislative mandates as well as accounting for public comment. One of the goals is to expedite the use of new technology, particularly in diagnostics, prosthetics, and therapeutic devices. This goal also emphasizes the need for collaborations among computer science, statistics, and engineering professionals and end-users. Another goal is enhancing pre-clinical work, basic science, and precision medicine.
The report sets a new stage for the direction of rehabilitation research within the U.S. Future research objectives include neurotechnology devices, offering five years of new opportunities for the industry.
