An International Perspective on Rehabilitation Engineering - Results from a Churchill Fellowship. David Hobbs, Regency Park Rehabilitation Engineering, Adelaide, SA, Australia. Introduction. The field of Rehabilitation Engineering (RE) and Assistive Technology (AT) has experienced significant growth in the last decade, led largely by the emergence of new and innovative technologies that have improved the lives of people with a disability. The influence of technology can be seen across all fields - from wheelchairs and seating to communication devices and aids for daily living. Rehabilitation Engineering Centres (RECs) around the world are conducting innovative research and development (R&D) and are consistently developing new products, programs, or services that improve the lives of people with a disability. Within an RE/AT context it is acknowledged that both basic and applied research has the potential to feed directly into improving clinical service programs and providing evidence for establishing 'good practice' models. If R&D is viewed as the engine of innovation and the precursor to new product development, how is this process guided and how successful is it? What 'research model' works best and what does this mean for R&D within the field of RE in Australia? The author undertook an 8-week Churchill Fellowship research program (Hobbs, 2003) to investigate how leading RECs around the world are using R&D and the application of technology to assist people with a disability. Twelve Centres [1] in England, Toronto, and the United States were researched, including specialist Rehabilitation Centres, departments within hospitals, and tertiary research facilities. The project aims were to identify successful R&D models (how the research was conducted, how it was funded, how research priorities were determined, and to what extent each centre collaborated with industry or other centres) and how new ideas and innovations were taken from a concept to commercial reality (technology transfer). A secondary focus was to investigate how the concept and process of 'Universal Design' (or 'Inclusive Design') was being taught and implemented within the field. Results and Discussion. A number of novel, user driven, innovative products and programs were investigated at the different centres. These came from areas such as seating, mobility, home health care, telecommunications, and the general area of AT. Many of these products, particularly those from Canada and the United States, are commercially available but have not reached our shores or are unknown to healthcare professionals in Australia. Examples include the Flip2sit booster seat, kidsert(r), SEATurtle, the Movement-to-Music therapy system, SoleSensor, LifeRail, Staxi(, the Rocket( power wheelchair, a cross-disability voting tablet, and a cross disability talking mobile phone. Some of these products are highlighted in Table 1. It is important, in the author's opinion, that Australian's working within the RE/AT field are made aware of these developments - at the very least this would avoid research duplication and possibly lead to international collaboration opportunities between different centres. Table 1: Examples of some of the new and novel products the author was introduced to while conducting his research: * Flip2sit booster seat; * SEATurtle; * kidsert; * LifeRail; * SoleSensor. Cross-disability voting tablet. A degree of cross-fertilisation was noted amongst the centres that were visited, with similar project areas being researched in different parts of the world. These included a focus on ageing and how AT can assist the elderly, and some aspects of Universal Design (two centres independently developed product evaluation kits to educate and inform users and product designers as to how 'inaccessible' their product was if someone with a disability tried to use it). Notably, every centre that was researched was either fully affiliated with a tertiary institution or operated as a department within a tertiary institution. This was a strength of their research program and a common successful trait of all the centres. The involvement of end users (or consumers) in R&D activities at all stages of project selection, research, development, and information dissemination was another common feature - although each centre differed in where in this process end users were involved (some involved them at the very beginning while others introduced them at later stages). A further successful trait was the establishment of collaborative links with industry or other tertiary institutions, particularly where there was an emphasis on technology transfer. In essence, no one worked alone - all centres had established strategic partnerships to varying degrees. The author was able to identify key ingredients of successful research, development, and technology transfer 'models' within the RE/AT field. These included: strong, visionary leadership; committed and dedicated teams; collaboration with industry and tertiary institutions; clear goals; productive and efficient use of students; the ability to learn quickly from what works and what doesn't; and a passion and desire to succeed within a small, niche field. Successful Research and Development Models. Two successful models are particularly noteworthy and deserve to be highlighted: the Canadian provincial Ontario Rehabilitation Technology Consortium (ORTC) model (see http://www.assistivex.com) and the United States federal National Institute on Disability and Rehabilitation Research (NIDRR) model (see http://www.ed.gov/offices/OSERS/NIDRR/). A critical ingredient of both of these models, which operated quite differently, was also noted - that of government support. Without government initiation and support, neither of these models would exist. The Ontario Rehabilitation Technology Consortium (ORTC) - Ontario, Canada. The ORTC was established in 1992 at the request of the Ontario Ministry of Health and Long-Term Care, with a funding commitment of CDN$15 million over ten years. To quote the words of Dr Morris (Mickey) Milner, ORTC Director, "It was understood that this came about because the Ontario government believed in the economic, health and social benefits of developing made-in-Ontario assistive products for people with disabilities 1". With a commitment to source matching funds to support their research and other activities, the ORTC became, as their vision statement declared, 'an engine of innovation' within the assistive device field. Although it was a provincial framework, the ORTC model was one of the most successful and innovative R&D models within the RE/AT field, and was recognised around the world. The ORTC's achievements in its first ten years were extremely impressive: a total of 32 products to market, 15 for licensing, and a further 14 in the pipeline; 29 patents awarded, 29 pending, and 27 trademarks awarded; an annual average of 42 refereed papers, 28 Conference proceedings, and 54 presentations; a total of 15 PhD's and 104 Masters (with 11 and 24 more, respectively, in progress); and established links with 31 active industrial partners as well as contributing to the development of 10 companies. An immensely impressive record given the niche field of RE/AT and the unique challenges associated with R&D. The Consortium had a focus on 'Technology Transfer' and getting their products and ideas out into the community, as well as involving consumers at as many stages as possible in the development process. The National Institute on Disability and Rehabilitation Research (NIDRR) - USA. NIDRR was the only federally funded, coordinated approach to support research and development within the RE/AT field that the author encountered during his Fellowship. One of NIDRR's main aims is to generate, disseminate and promote new knowledge to improve the options available to people with a disability. Created in 1978, NIDRR is a national leader in sponsoring rehabilitation research, funding approximately 300 projects annually through thirteen project areas. Funding is typically for 3-year periods, after which another application must be made for continued support (although NIDRR-funded Rehabilitation Engineering Research Centers (RERCs) and Rehabilitation Research and Training Centers (RRTCs) are funded for five years). NIDRR's total proposed fiscal year 2001 budget was US$141 million (US$100 million for research and US$41 million for technology requirements), which enabled it to support 344 projects. NIDRR conducts its research through a network of individual research projects and 'centers of excellence' throughout the United States. Most NIDRR grantees are universities or providers of rehabilitation or related services. Of the thirteen program areas NIDRR funds, two of the largest are the Rehabilitation Engineering Research Center (RERC) and Rehabilitation Research and Training Center (RRTC) programs. There are currently 27 NIDRR-funded RERCs and 42 NIDRR-funded RRTCs across the States. The specific project title and aims of each of the RERCs and RRTCs can be found at the following website: http://www.naric.com/search/pd/indextype.html. Conclusion. If Australia is to develop a similar research, development, and technology transfer base within the RE/AT field, government support must be solicited. In soliciting support, key stakeholders must emphasise the importance and relevance of the RE/AT field and the extent to which it benefits people with a disability. To quote from the Mission Statement of the Coalition of Rehabilitation Engineering Research Organizations (CRERO - see http://trace.wisc.edu/crero) in the United States, the field of rehabilitation engineering must educate and demonstrate "to the public, policy makers and legislators the potential and importance of Rehabilitation Engineering research and training outcomes related to the life goals of persons with disabilities". References. Hobbs, D.A., 2003, To investigate how leading Rehabilitation Engineering Centres around the world are using research and development, Universal Design, and the application of technology to assist people with a disability, 80-page report submitted to The Winston Churchill Memorial Trust of Australia, 18th September 2003. A full copy of the author's report can be downloaded from the following website: http://www.churchilltrust.com.au/03flwsrpts_t2.html#Technology [1] The centres that were researched were: * Centre for Disability Research and Innovation, Royal National Orthopaedic Hospital, Stanmore, London, UK, http://www.ucl.ac.uk/orthopaedics/Staff/CDRI.htm * King's Health Rehabilitation Engineering Division, Bowley Close, and the Centre of Rehabilitation Engineering (CoRE), the Department of Medical Engineering & Physics, King's College Hospital, Denmark Hill, London, UK, http://www.kcl.ac.uk/core * Engineering Design Centre, Cambridge University Engineering Department, Cambridge University, Cambridge, UK, http://www-edc.eng.cam.ac.uk/ * Oxford Centre for Enablement, Nuffield Orthopaedic Centre National Health Service (NHS) Trust, Oxford, UK, http://www.noc.nhs.uk/special.html * Bloorview MacMillan Children's Centre, a member of the Ontario Rehabilitation Technology Consortium (ORTC), Toronto, Ontario, Canada http://www.bloorviewmacmillan.on.ca/ and http://www.assistivex.com * The Centre for Studies in Aging, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada (also a member of the ORTC) http://www.swchsc.on.ca/~csia/ * Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute, Toronto, Ontario, Canada http://www.utoronto.ca/IBBME/Faculty/Popovic_Milos/rel_uoft.html * Trace Research & Development Center, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA, http://trace.wisc.edu * The Center for Universal Design, College of Design, North Carolina State University, Raleigh, North Carolina, USA, http://www.design.ncsu.edu/cud/ * Department of Industrial Design, College of Architecture, Georgia Institute of Technology, Atlanta, Georgia, USA * Center for Assistive Technology and Environmental Access, College of Architecture, Georgia Institute of Technology, Atlanta, Georgia, USA, http://www.catea.org * Attended the 26th Annual Rehabilitation Engineering Society of North America (RESNA) Conference, Atlanta, Georgia, USA, http://www.resna.org 1 Ontario Rehabilitation Technology Consortium 10-Year Report 1992-2002, Pg.7 Email correspondence to david.hobbs@cca.org.au END.