September/October 2017

Engineering for Independence

While many PEs enjoy work that benefits the public, rehabilitation engineers thrive on one-on-one relationships with their clients.

BY TAYLOR WANBAUGH

GLENN HEDMAN, P.E., WORKS WITH CLIENTS OF THE ASSISTIVE TECHNOLOGY UNIT CLINIC AT THE UNIVERSITY OF ILLINOIS AT CHICAGO.

It was the early 1980s and Jon Schuch was a graduate student in the University of Virginia’s rehabilitation engineering program. When Schuch was assigned a young kid named Michael for his summer clinical project, he did not yet know how this young boy would change his life and passion for his career.

Michael was not a typical kid. A high spinal cord injury prevented him from doing many things that most children take for granted: running, playing, eating, and even breathing on his own. He came from an area of Virginia that didn’t have many options when it came to assistive and rehabilitative technologies. That was, until the University of Virginia rehabilitation engineers stepped in.

In a matter of months, a new motorized wheelchair was engineered for Michael, one equipped with a microjoystick he operated with his chin. Michael, armed with a grin on his face, would zoom through the hallways of the UVA hospital. He would flash a pretend driver’s license that the engineers had the DMV make for him at the nurses who jokingly threatened to “pull him over for speeding.”

The team went on to acquire and adapt a personal computer for Michael, set up an environmental control system for him, and create other assistive technologies that allowed him to complete a variety of tasks. Schuch says the whole medical staff formed a special bond with the young boy, and seeing him thrive due to assistive technology was incredible rewarding.

“It was such a meaningful relationship,” says Schuch, a professional engineer who now works as director of occupational health and wellness at the University of Virginia Health System. “He changed my life more than I could have ever changed his.”

See a Need, Fill a Need

Professional engineers thrive on the ability to see a problem and find a solution. Nothing could be truer for those PEs who work as rehabilitation engineers. They use their skills to design, develop, adapt, apply, and evaluate solutions to barriers met by people with disabilities. The needs addressed by rehab engineers can include mobility, communication, hearing, vision, and cognition.

According to a 2010 study by the Census Bureau, about 56.7 million people in the US, or nearly 1 in 5, have a disability. More than half reported that the disability was severe.

“We want to maximize educational pursuits, independent living, employment opportunities—to be gainfully employed and successful, to be able to do recreation and any leisure activities,” Schuch says.

To meet these goals, rehab engineers are responsible for working with medical teams, therapists, and manufacturers to create different types of assistive technology that fit each client’s own needs.

Glenn Hedman, P.E., spends most of his time working with clients of the Assistive Technology Unit clinic at the University of Illinois at Chicago. As director of the unit, Hedman often meets with clients and conducts evaluations to figure out what type of technology would best suit them and their lifestyle before creating a plan of action. The clinic handles a wide range of assistive technology, including manual and powered wheelchairs, communication aids, and computer access equipment.

Hedman, whose focus is on home and worksite modifications, says that his favorite part about working in the clinic is “the opportunity for feedback on design work.”

“It’s a field where, working in the clinical setting, you get 100% feedback because the design and fabrication work that you’re doing is done for a specific end user,” says Hedman, a past president of the Rehabilitation Engineering and Assistive Technology Society of North America. “You are a part of a team that’s providing that equipment, and you see the results of the use of that equipment.”

Depending on the client’s needs, sometimes rehab engineers must devise a brand-new technology. Other times, it’s a matter of modifying equipment that already exists and the client already uses. It can even come down to rehab engineers figuring out how multiple manufactured components of assistive technology can be combined to best serve an individual’s needs.

“Engineers sometimes use their knowledge base to mix components from different manufacturers to arrive at somewhat of a hybrid solution,” says Hedman. “A wheelchair could come from one manufacturer while a mounting system for a communication aid to be installed on that wheelchair comes from another manufacturer. But an engineer may use his or her skills to make sure that both systems—the wheelchair and the mounting system coming from different companies—are compatible. They need to make sure that a match is made between the equipment.”

Another important factor rehab engineers must consider is an age-old question: Will the solution stand the test of time? They must think about how the client’s needs might change over time and adjust their thinking to include a timeline of a disability.

“It takes some education and experience to really adjust or produce a product customized for people with disabilities,” says Mark Bresler, P.E., a rehabilitation engineer at the Georgia Vocational Rehabilitation Agency. “It needs some expertise: How is this disability going to change over the years? Disability plus aging. Family and caregivers need to think how to proceed in 10 years.”

A Metamorphosis

Rehabilitation engineers like Schuch, who have been in the field for over 30 years, have personally borne witness to the discipline’s evolution. A lot has changed. The development of assistive technology is speeding up, thanks to advances in 3D printing and materials. Much more assistive technology is commercially available than in years past, and the need for engineers to fabricate completely new devices is becoming less common.

Schuch thinks the advancements in technology have been “fantastic” for the field, and he looks forward to further developments.

“I’m waiting to see a good daily use of robotics where you could have some robotic assistance for people with disabilities,” says Schuch. “The technology—with computers, artificial intelligence, things such as 3D printing—is changing the field and will change it even more dramatically over the years.”

Not all the changes that have occurred in the field have been beneficial to the rehab engineering community, however. As more technology becomes commercially available and mass produced, the quality and longevity of a product can suffer.

“Manufacturers are utilizing a lot of companies overseas who provide their equipment,” says Schuch. “We have a very significant lack of quality control at times…. It begs the question: Are we just selling stuff cheap to make a profit?”

Outsourced manufacturing and greater involvement of health professionals in the assistive technology field have also led to a decline in job opportunities for rehab engineers in the clinical setting. This, in turn, has led to a decrease in college-level programs geared specifically toward assistive technology and rehabilitation engineering.

Hedman has seen an interest from students in rehab engineering, but he is concerned that there are not currently enough jobs available after graduation.

“Disability-related projects are extremely attractive to students,” says Hedman. “There’s feedback that you get back on a design, every situation is a little bit different, every person is different. It’s a unique problem that’s presented to a student or a student team…. For [students] to be attracted into the field, there need to be jobs. On the clinical side, engineers are not as prevalent anymore.”

Another trend affecting the practice of rehabilitation engineering is the increasing human life span due to advances in science and medicine. According to a study conducted by the Population Reference Bureau, the risk of dying early from diseases has decreased due to better methods of treatment and prevention. The average age of the world’s population is increasing. For the first time ever, there are more people over the age of 65 than people younger than 5. The study says that by 2050, the number of people 65 and over will reach 1.5 billion, or 16% of the world population. In 1950, it was only 5%.

As people with disabilities live longer, the need for rehab engineers increases. “This type of engineering can make a big difference with clients with disabilities,” says Bresler.

Engineering One on One

Despite the challenges rehabilitation engineers face, their work is extremely valuable to the community. Where others might see obstacles, these engineers witness countless rewards such as seeing an end user’s reaction to a device they created and helping to make a difference in the lives of people with disabilities.

Hedman says he values having direct contact with his clients and seeing his work positively impact their daily functioning.

“You’re getting that feedback and their reaction to using that equipment,” says Hedman. “You hopefully hear from them as to what this will enable them to do.”

To this day, Schuch still remembers the deep connection he had with little Michael while in graduate school years ago. For him, the “people connection” is what makes rehab engineering truly unique.

“For any type of engineering, the work is for the benefit of the planet, the benefit of people. But it’s not quite as direct and immediate.… It’s helping masses of people, rather than one, but it’s more of an indirect connection. This is truly a relationship, one-on-one…it’s what’s kept me connected to this and really energized,” says Schuch. “For people with disabilities, this technology is so critical for them to get to experience and achieve the things that others do.”