Rancho Los Amigos Medical Center. A unique orthopaedic resource and teaching institution

Rancho Los Amigos Medical Center, initially a poor farm in the County of Los Angeles, CA became a world renown medical institution because of the polio epidemics in the 1950s. Responding to the need for day to day inpatient care were an overflow of victims of polio who had spine and extremity weakness and were dependent on respirators. Team care, developed at the institution, was used by Vernon L. Nickel, chief orthopaedic surgeon so that maximum use of the limited staff's efforts would be to take care of patients. This need spawned many innovative developments through clinical observations and trials, basic research, and engineering innovations that resulted in the patient's functional improvement and helped return many victims of polio to independence and to their communities. Subsequently, orthopaedic surgeons, Jacquelin Perry, and Alice Garrett joined the full-time staff as the workload increased. Stabilizing the spine using fascial supports, spinal fusion, spinal instrumentation, orthoses, and seating systems allowed those patients who were not totally dependent on respirators to be upright and mobilized. When polio was eradicated, newer programs were established for physically disabled persons with musculoskeletal disorders affecting the spine and extremities and for those patients with congenital, acquired, neurologic, and neuromuscular disorders. In formal graduate residency affiliations, fellowships, and continuing medical education programs orthopaedic surgeons from around the world have been taught the basic principles of "categorical care" for physically disabled people for 50 years. Orthopaedic care given through these programs formed the basis of a new orthopaedic subspecialty, Orthopaedic Rehabilitation.

Children, disability and rehabilitation in history

Pediatric Rehabilitation is starting a new section in the journal. 'Voices from the Past' will combine two forms of articles. The first will be reviews of, and where possible, republication of the 'classic' articles in the field of paediatric rehabilitation. Summaries and discussions of these seminal contributions will at least be presented. The second will be scholarly studies of historical topics within the fields of paediatric rehabilitation, childhood and disability. Recent research in the histories of childhood and disability is reviewed in this essay.

Physical medicine and rehabilitation at the Mount Sinai medical center during the 20th century

The Department of Rehabilitation Medicine at the Mount Sinai Medical Center has a long history, beginning in 1910 with the establishment of the Department of Physical Therapy, headed by Heinrich Wolf, M.D. In 1935, William Bierman, M.D., was appointed director. He was, at that time, one of the leading physicians of physical therapy in the United States, and a prolific researcher, writer and clinician. In 1948, the name of the department was changed to the Department of Physical Medicine, reflecting the newly established specialty of the Board of Physical Medicine. In 1959, Lawrence Wisham, M.D., was appointed chairman, and shortly thereafter the name of the department was changed to Physical Medicine and Rehabilitation. Under Dr. Wisham's leadership, services were provided to inpatients on the acute wards of the hospital, and to outpatients. In 1968, the name of the department was changed to Rehabilitation Medicine. In 1986, Kristjan T. Ragnarsson, M.D., became chairman of the department, and shortly thereafter an inpatient rehabilitation medicine service was established and outpatient services expanded. Since that time, rapid growth has occurred within the department, particularly in delivery of clinical services and research. The role of rehabilitation medicine in the delivery of clinical services to people with temporary or permanent disability is now well established, but efficient and effective delivery must be ensured in the current and future healthcare environment.

[Silencing the innocents: punitive measures used in the rehabilitation of minors in disciplinary establishments maintained by the state, 1945-64]

Por meio da análise de documentos do Arquivo do Serviço Social de Menores do Rio Grande do Sul, o presente artigo pretende estabelecer a relação existente entre a prática punitiva em estabelecimentos disciplinares do SESME, no período de 1945-1964, e a existência de um médico, jurídico, filosófico e pedagógico que preconizava a disciplina enquanto estratégia de recuperação de menores, abandonados ou infratores, sob a custódia do Estado.

Occupational therapy and rehabilitation: an awkward alliance

This article argues that although occupational therapy and rehabilitation are often considered synonymous, the latter is but one aspect of the former. Early influences on occupational therapy are briefly reviewed, and some philosophical ideas about activity are described. The rationale for the use of occupations as treatment in the early part of this century, both in Canada and in the United States, is examined and contrasted with the development of physical medicine and rehabilitation after World War II. This discussion demonstrates that the origins of occupational therapy and rehabilitation in North America had little in common. As occupational therapy became incorporated into rehabilitation, the profession's core values eroded, and although current definitions of rehabilitation offer a more appropriate fit for occupational therapy, rehabilitation continues to see engagement in occupations as a separate and subsequent step. The article concludes by considering future directions and the tasks that lie ahead.

The history of physical medicine and rehabilitation as recorded in the diary of Dr. Frank Krusen: Part 4. Triumph over adversity (1954-1969)

This article, the last of four based on the diary of Dr. Frank H. Krusen, picks up the story of physiatry's conflict with other medical specialty groups within the American Medical Association. The conflict was focused on PM&R's use of the term "rehabilitation," but the underlying motive of groups opposing physical medicine was to limit the scope of physiatric practice. Dr. Krusen organized a well-documented and successful defense of the specialty and opened the door to the development of comprehensive care of persons with disabilities. Also related here are Dr. Krusen's legislative and public relations contributions to PM&R from 1963 until his retirement from Tufts-New England Medical Center in 1969. Dr. Krusen retired to Cape Cod and died there in 1973.

The history of physical medicine and rehabilitation as recorded in the diary of Dr. Frank Krusen: Part 3. Consolidating the position (1948-1953)

This article is a continuation of the story of the struggle to win recognition of physical medicine and rehabilitation as a medical specialty, as told in the pages of a daily diary kept by Frank H. Krusen, MD, from 1943 through 1967. The first two articles described Dr. Krusen's professional development before 1943, his efforts to establish a certifying Board for physiatrists, and the role of the Baruch Committee on Physical Medicine in Krusen's eventual successes. This article focuses on how Krusen and his physiatric colleagues campaigned to gain acceptance by organized medicine of the new specialty, to unite the fields of physical medicine and rehabilitation, and to identify and maintain the scope of physiatric practice despite challenges from other specialties.

The history of physical medicine and rehabilitation as recorded in the diary of Dr. Frank Krusen: Part 1. Gathering momentum (the years before 1942)

Frank H. Krusen, MD, was arguably the most influential member of the small group of physicians who began in 1938 a long and difficult struggle to win acceptance of physical medicine and rehabilitation as a medical specialty. The struggle was aided immeasurably in 1943 when a millionaire philanthropist, M. Bernard Baruch, financed the establishment of the Baruch Committee on Physical Medicine. Dr. Krusen became the Director-Secretary of the Committee and began to keep a daily diary in which he recorded his activities and those of his colleagues in their quest for recognition of PM&R as a specialized field of medical practice. That recognition came in 1947 with the establishment of the American Board of Physical Medicine, but Dr. Krusen continued his diary through 1967. In 1988, 15 years after his death, Dr. Krusen's family donated a copy of the diary to the History of Medicine Library of the Mayo Clinic in Rochester, MN. The gift coincided with the American Academy of Physical Medicine and Rehabilitation's celebration of its 50th anniversary. This article, the first of four, introduces the reader to Dr. Krusen and describes his early years and his professional development in the years before 1943.

The history of physical medicine and rehabilitation as recorded in the diary of Dr. Frank Krusen: Part 2. Forging ahead (1943-1947)

Presented here is a continuation of the story--as drawn from the diary entries of Frank. H. Krusen. MD--of the struggle to gain recognition for, and acceptance of, physical medicine as a medical specialty in its own right. It details the events, as described by physical medicine's strongest protagonist, between 1943 and 1947 that led finally to the establishment of the American Board of Physical Medicine. The millionaire philanthropist Bernard Baruch provided the financial resources that were required to establish academic and clinical programs in the field of physical medicine. Dr. Krusen was a key member of the Baruch Committee on Physical Medicine, which provided over sight for the newly created programs. His thoughts and sentiments concerning his role in the struggle, as he recorded them in his diary, are reported here.

A history of low vision and blind rehabilitation in the United States

The author presents a history of services for the blind and those with low vision in the United States focusing on the areas of orientation and mobility, and rehabilitation teaching. The controversies involving the development of these specialties are discussed. Emphasis is placed on the role of Father Thomas Carroll in the establishment of low vision and blind services for the military and veterans administrations. Published data regarding the past role of ophthalmologists in obtaining low vision services for patients is reviewed. The opportunity for a more active role for ophthalmologic involvement in the rehabilitation of the low vision and blind patient is discussed.

A century and a half of psychiatric rehabilitation in the United States

Psychiatric rehabilitation, which is aimed at helping persons who have long-term mental illness to develop their capacities to the fullest possible extent, has been an integral part of psychiatric treatment in the U.S. since the beginnings of moral treatment in the early 19th century. The author outlines broad historical developments and prominent current modalities and models of psychiatric rehabilitation, including the introduction of family care, the day hospital, social skills training, psychoeducation, and the Fountain House model. He discusses the conceptual underpinnings of the field, such as the need to work with the healthy part of the patient and changes in views on vocational rehabilitation. Current concerns include the possibility of overselling rehabilitation and of misusing the term "recovery."