Clearly, we have to match up some financial assistance with motivation to make that a very usable kind of help.

Mr. JEFFORDS. Thank you.

Thank you, Mr. Chairman.

Mr. OWENS. Again, we thank all of the panelists. We are going to proceed on the basis of what you have communicated to us this morning, and in your written testimony.

But what you have communicated by your presence is invaluable, and I thank you again for coming.

Our next panel consists of Ms. Alexandra Enders, Project Manager, Rehabilitation Engineering Delivery Program, Electronics Industry Foundation; Dr. Barbara Boardman, Senior Analyst, Health Program, Office of Technology Assessment; and, with your indulgence, because of a time problem, Mr. Jerry Weisman, from Rehabilitation Technology Services in Burlington, Vermont.

We'll take Mr. Weisman first.

Is there anyone in the audience who would need an interpreter? We can continue this if there is a need for it. Is there anybody who still needs one?

All right, thank you.

We will proceed.

I'll let Mr. Jeffords introduce Mr. Weisman.

Mr. JEFFORDS. Thank you very much, Mr. Chairman.

It's with a great deal of pleasure that I introduce to you Mr. Gerald Weisman.

He has a Master's degree in mechanical engineering, and is one of the project directors on the staff of the University of Vermont's Rehabilitation Center for Lower Back Pain, and in addition is with Rehabilitation Technology Services, a private company which designs and makes individualized technological and mechanical accommodations for individuals with disabilities.

Such accommodations have been made by Mr. Weisman for children and adults to increase their ability to participate in their homes, at school, and at work.

We all like to think that we impact positively on the lives of others, and Jerry has demonstrated how to do it for the last 12 years.

We deeply appreciate your presence. Thank you, Jerry.

Mr. OWENS. Mr. Weisman, you may proceed.

STATEMENT OF MR. JERRY WEISMAN, REHABILITATION
TECHNOLOGY SERVICES, BURLINGTON, VERMONT

Mr. WEISMAN. Thank you.

Mr. OWENS. Can you pull the mike closer?

Mr. WEISMAN. It's an honor to be here today.

As a rehab engineer for the last 12 years, I've been involved with and responsible for the delivery of rehab technology services to persons of all ages with all types of disabilities.

It's easiest for me to show you what types of things are involved by bringing slides with me.

Having grown up in Brooklyn, and lived on Vernon Avenue for a while, I moved to Vermont. I've brought along a slide that's hard to see. There are some misconceptions about the size of Vermont

since we only have one Representative to Congress. But you can see from this

[Laughter.]

Mr. WEISMAN. The importance of the work at our Rehab Center can be seen from our next two slides. Some 75 million Americans are affected by chronic lower back pain. The cost of this lower back pain is estimated to be about $56 billion a year.

We hope that the work that we're doing at the Rehab Engineering Center will have an impact on these numbers. What I'd like to do, because I can't bring all the clients that I've worked with, is to bring some slides and show you some of the things that we've done. When I first met Danny, he was two years old and had cerebral palsy. He couldn't get around by himself. We wanted him to be able to get around by himself so he could get into trouble the way all two-year-old toddlers do. We bought a cart from Sears for about $125 and modified it for about $250, and he could get around all by himself.

Sean was 12 when he first came to us, positioned already in a chair, but never having been able to get from one place to another by himself. We modified his chair and developed a wheelchair control system for about $1,000 that allowed him to get from one place to another. Watching his father watch him was like watching a father watch his son drive a car for the first time.

Maura was in high school when we first met her, with cerebral palsy using an Apple computer to do all her homework. She uses two switches allowing her to use Morse code through a commercially available product known as a Firmware card, to access the computer. She can type about as fast as anybody who uses the huntand-peck method.

Bob was a quadriplegic who was a photographer before becoming injured with a spinal cord injury. Rather than spending $600 or $700 on a fancy new electronic camera that he may have been able to use, we just modified his old one for about $100. He could then still take pictures and enjoy photography.

I apologize for the darkness of this slide. It shows a threewheeled cart that we made for Rick. Rick was 17 years old when we met him, and lived in Boston. He had a family that was very outdoorsy. They liked to be outside but couldn't find a wheelchair that would hold up outside. We made him this three-wheeled cart for about $150.

His father started to push him in road races, and they eventually ran in the Boston Marathon. They've been running the Boston Marathon for the last six or seven years, and have since entered Iron Man competitions.

This was Joe, who was a barber for about 30 years and then lost a leg to an amputation. He couldn't stand up all day and still provide all the services that he did. For a couple of hundred dollars, we got a chair so that he could still provide all his services and keep his shop open.

Daisy was a person who lived in upstate Vermont who wanted to be able to sew, but because of her double above-knee amputation, she had no feet to operate a foot pedal on an industrial sewing machine. It was replaced with a pneumatic cylinder and a head control was developed, and she could sew, becoming one of the fastest operators in the plant, using that head control.

Horse was a lineman for a cable television company who fell off a pole, broke his back and became a paraplegic. He had worked for this company for 7 years and was a good employee, and the employer wanted to keep him.

He demonstrated his abilities and what he could do, and demonstrated that he could get up into the bucket of a truck with his long leg braces. Once he was in that bucket, he was the same as anybody else, and could go back to work with about $3,000 of modifications to his truck. Most of these were things like grab bars on the outside of the truck that he could hold onto as he walked around.

There were benches added to the inside so he could have mobility inside the truck. In Vermont, it's important to have heaters in the bucket, if you're working on top of the pole in winter, and hand controls to drive them.

We have a saying in Vermont that you can't get there from here, and sometimes you need snowshoes to get there. We have a company in Vermont which makes snowshoes, and they use a lot of home work people, to make these snowshoes at home.

David used this old rig that held a snowshoe rigidly, but because of his limited mobility and hand dexterity, he easily became fatigued and couldn't work more than half a day. We made up a rig that allowed him to rotate the snowshoe while he worked on it. In that way, he could sit on a stool in one place and be productive all day long.

On a personal level, these examples of technology are as significant as landing a man on the moon. But at the same time, they're not pie in the sky solutions. We're not spending a lot of money on these things.

The prospect of legislation enabling the development of rehab technology services for people with disabilities of all ages is very exciting, and one that's most welcomed by the Vermont Rehab Engineering Center and Rehab Technology Services.

In considering such legislation, at least six issues should be addressed, in order to ensure that quality services are provided in an efficient and cost-effective manner by competent people.

Acquiring appropriate technology has greater implications than simply acquiring the funds to purchase commercially available equipment. Services that go beyond traditional medical and rehab models include specific technology expertise that must be provided to ensure the appropriateness of the technology.

None of the examples provided above would have been possible if we were dependent solely on the commercially available products. Reinventing the wheel is a common activity in the present dissident network of service providers. A network should be developed to share the engineering so that it does not have to be duplicated. Thirdly, programs to increase awareness are extremely important in the effort to provide technology assistance. There is an obvious need for the training of rehabilitation engineers. Legislation to establish rehabilitation technology service programs will greatly increase the needs for technologists, especially rehab engineers. The current shortage of engineers in the service sector will become extremely acute, unless a concerted effort is made to establish training programs to produce these professionals.

Fourth, legislation to establish technology service programs must address the need to fill the gaps of present funding for adaptive equipment delivery mechanisms, and not duplicate it.

Five, at the present time there is no way to identify a qualified rehab technology service provider. The expansion of service delivery programs with the concomitant infusion of monies makes the identification of these qualified personnel most important.

Lastly, the lack of liability insurance for many technology providers presents some major problems, not only to providers themselves but to their clients and to society.

The single biggest problem with the lack of liability coverage for assistive technology providers is the lack of protection afforded the consumers of these services.

The benefits of technology to the lives of persons with disabilities have been clear for some time. The time is right to enable the development of comprehensive rehab technology service delivery models through legislation.

We at the Vermont Rehab Engineering Center for Lower Back Pain and Rehab Technology Services support this legislation, and are committed to doing anything we can to help bring these concepts to fruition.

Thank you very much.

[The prepared statement of Gerald Weisman follows:]

STATEMENT OF Gerald WeismaN, M.S.M.E., REHABILITATION TECHNOLOGY SERVICES, VERMONT REhabilitation ENGINEERING CENTER

It is an honor to be given the opportunity to testify before the Subcommittee on Select Education and Labor pertaining to technology related needs and assistance for persons with disabilities.

As a rehabilitation engineer for the last 12 years I have been involved in, and responsible for the delivery of rehabilitation technology services to persons of all ages and with many types of disabilities. At the present time, I am one of the Project Directors for the Vermont Rehabilitation Engineering Center (REC) for Low Back and the Director of Rehabilitation Engineering for Rehabilitation Technology Services, an affiliate of the Vermont REC and the University of Vermont.

The Vermont REC is one of the NIDDR funded rehabilitation engineering centers and the only one whose focus is low back pain. Vermont has recently been awarded a second 5 year grant to continue the work begun 5 years ago. The mission of the Vermont REC for Low Back Pain is the improvement of our understanding of the diagnosis and successful rehabilitation of people with low back pain (LBP), with the ultimate goal of improving quality of life of these individuals and reducing the socioeconomic costs of LBP through a comprehensive and integrated program of multidisciplinary research and information dissemination activities.

The successful rehabilitation of those who LBP is of critical medical and socioeconomic importance. LBP, the most common musculoskeletal disorder, is also the single greatest source of compensation payments, and the second most common cause of work loss. The number of Americans affected by chronic backaches is estimated to be 75 Million. Prevalence rates are increasing as is the attendant disability. According to the National Center for Health Statistics, impairments of the back or spine (excluding spinal cord injury) are the third leading cause of impairments in the U.S., affecting 11,700,000 persons (5.2% of the population), second only to hearing and sight impairments. However, disabling impairments of the back or spine are the leading cause of disability in the U.S., affecting 5,300,000 (2.3%) of the population. Between 1971 and 1981, the numbers of people with back or spine disabilities increased by 168%, while the population of the United States increased by 12.5%. Seventy-nine percent of these persons are in the age group 17-64, the peak of productive, wage-earning years. Corporate expenses alone, involving the treatment, lost production and retraining due to LBP have been reported to exceed $56 Billion in 1987.

In the past four years, the Vermont REC has undertaken several studies that have incorporated the design, development and evaluation of new technology. These

include measurement tools (3-axis goniometer, hand-held force meter, isokinetic strength tester), surgical instrumentation (Vermont Spinal Fixator), a compliance meter for monitoring brace and corset wear, and various types of experimental apparatus. Additionally, a computerized patient questionnaire has been developed to make it possible to gather information on a wide range of factors presumed to influence outcome of low back episodes and thus lead to the prediction of whether or not a person will become disabled due to LBP. Current projects will continue to; identify risk factors for back injury, pain and disability; develop measurement methods for assessing strength, rehabilitation potential and effectiveness; evaluate various treatment including orthotics, movement, manipulation and exercise; develop methods for assessing both worker and workplace to enhance the development of worksite design and modifications to reduce or eliminate low back injury and to facilitate early return to work for those injured; expand as a nationally-recognized repository of information on the diagnosis, treatment and prevention of LBP.

Rehabilitation Technology Services (RTS) is a primary mechanism through which technological advances developed at the Vermont REC are applied to meet the needs of people with disabilities. RTS's primary purpose is to improve the quality of life of such individuals through the efficient and cost effective delivery of rehabilitation technology services. Engineering consultations are provided to identify problems and seek appropriate solutions. Resources are maintained for the modification and fabrication of equipment. RTS offers consulting services and technical assistance in the areas of worksite modifications, mobility, seating and positioning, communication, activities of daily living needs, educational needs and architectual accessibility. These services have been provided to persons of all ages with many types of disabilities.

RTS is the primary provider of rehabilitation technology services in Vermont. Services are provided through contracts and fee-for-service through such agencies as the state Vocational Rehabilitation agency, Handicapped Children's Services, special education departments, acute rehab facilities and public and private rehabilitation and business organizations.

Having provided rehabilitation technology services in the northern New England area for the last twelve years I have been witness to the increasing awareness and interest of persons with disabilities and professionals in the benefits of technology. A few examples of rehabilitation technology services will illustrate the process as well as the benefits.

Dan was two years old when his parents thought it would be a good idea for him to be able to get around by himself. Because of cerebral palsy Dan was unable to walk or even move around independently. He therefore couldn't explore his environment and "get into trouble" as all toddlers are apt to do. A toy cart was purchased from Sears for $125 and modified at a cost of $250 to enable Dan to operate it independently. Dan has acquired the ability to move through his environment independently. Most of the benefits of this mobility will manifest themselves later in Dan's life as near normal psycho-social development.

Sean was 12 years old before he was given the opportunity to move from one place to another without assistance. A custom designed wheelchair control system enabled Sean to retain the benefits of his existing postural wheelchair. The $1,000 spent by the school system to modify Sean's chair was soon seen to be cost effective as Sean began to work in the school cafeteria sweeping the floor with the broom attached to his powered chair.

Marla is a very intelligent young woman. Functional limitations due to cerebral palsy prevented her doing much of her homework in high school in a traditional way. A modification known as a "firmware card" enabled Marla to access an Apple computer through two switches. The switches represent the dots and dashes of morse code. By properly positioning the switches, Marla has independent access to the computer. Using morse code, she can type almost as fast as someone using the "hunt and peck" method of typing. She is now in college and on her way to a bachelor's degree.

A spinal cord injury at the C-7 level left Bob a quadriplegic with no use of his fingers. An avid photographer, Bob hoped a way could be found to allow him to continue to take pictures. After looking at new "electronic" cameras that cost upwards of $650 and were too expensive for Bob, a way was found to modify his own camera for about $150 to enable him to access the various controls. A commercially available support was purchased and mounted to his wheelchair. Bob continues to receive enjoyment and satisfaction from his hobby.

Rick belongs to a very special family that enjoys the outdoors. In spite of his cerebral palsy he participates fully in family outings. When he was 17 the need for a wheelchair that could be pushed but not fall apart when going over rough terrain