COMMENTARY

By: Tyler M. Saumur

“It is the science of rehabilitation” – this would not be an uncommon response from a random pedestrian, if asked “what is rehabilitation science?” Rehabilitation science is a young field composed of many founding disciplines such as medicine, social sciences, and engineering; this diversity creates a bountiful, broad science, but one with a divided identity. (1) To establish a level of distinctiveness, it is necessary to determine a common goal for rehabilitation science, separating it from its predecessors. This objective creates a richer distinction to stakeholders, such as community members and funders, that rehabilitation science is much more than just “the science of rehabilitation.”

As a master’s student in rehabilitation science, I have been exposed to a variety of research topics in our department, ranging from the use of knowledge translation terminology in research (2), to the effects of functional electrical stimulation on individuals with tetraplegia (3), and everything in between. This expanse of research exemplifies the breadth of knowledge encompassed by rehabilitation science. With that in mind, there has been ardent debate regarding whether basic science research, let alone research on healthy individuals, falls within this scope, considering its lack of direct clinical applicability (Polatajko, Helene. Discussion with: REH1100H class. 2015 Dec 08). While I appreciate the significance of direct clinical applications, my opinion is that basic science research is also essential to rehabilitation.

Basic science encompasses bioscience and human function studies, both of which are fundamental to understanding the impact of disease and mechanisms of recovery. This understanding is of paramount importance to both rehabilitation research and practice. (4) As an example, basic science studies examining physiological responses to interventions can inform treatment modifications to facilitate better recovery while minimizing injury risks. Without such explorations of physiological processes, our enhancement of rehabilitative interventions would be crippled.

Although basic science research on diseased populations may seem imperative to rehabilitation science, I further argue that studies on healthy individuals also have a role in the field. This research allows for a better understanding of human function and physiology, lending to the development of measurement tools and interventions. As an example, a study by Tanaka and colleagues (2009) explored the effects of transcranial direct current stimulation (tDCS) on leg motor function and cortical excitability, with direct implications for rehabilitation. (5) It provided evidence that tDCS could enhance leg motor performance, a valuable finding applicable to neuro-rehabilitation for stroke and Parkinson’s disease. As well, Domingo and Ferris’ study (2009) on healthy individuals found that physical assistance during walking balance training could be detrimental to motor learning. (6) This finding guided future rehabilitation research on motor learning strategies. Furthermore, research on healthy individuals also creates accessible control data, such as brain scan repositories and genetic data banks. These databases are essential to comparative analyses within rehabilitation science.

In further support of basic science’s relevance to rehabilitation, the National Center for Medical Rehabilitation Research’s (NCMRR) agenda is exemplary. NCMRR provides resources for training its researchers to explore basic science. (7) In their research plan, the NCMRR identifies knowledge of typical development and both changes in functional capacity and capabilities due to injury/disease as being pivotal areas of medical rehabilitation research. Similarly, the International Classification of Functioning, Disability and Health (ICF), one of the most widely used conceptual frameworks in rehabilitation science, also supports the inclusion of basic science in rehabilitation. (8) Within the ICF’s framework, body function and structure is a fundamental component. It is considered a vital domain within this classification of health and disability.

The hybrid nature of rehabilitation science is truly wonderful, fostering a collaborative and diverse environment. That being said, there is no globally accepted definition of rehabilitation science. Rather, various individual notions exist regarding the topics it encompasses. While definitions are useful in outlining conceptual boundaries, is it possible to create a universal definition for any field of study? The values and areas encompassed by any discipline will likely depend on those held by the individuals involved.

However, there is a wide array of support for the inclusion of basic science in any definition of rehabilitation science. This inclusion is supported by the NCMRR’s training foci, the ICF framework, and the applicability of research findings to rehabilitative practice. Studies involving healthy humans comprise a core foundation on which rehabilitative progress relies.

As a rehabilitation science researcher, my primary goal is to improve the quality of life of individuals suffering from disease or injury. It is my belief that regardless of a specific project’s aims, if the long term goal of the research is to improve quality of life for individuals with health conditions, it should be considered an integral part of rehabilitation science.

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References

1. Bartlett DJ, Macnab J, Macarthur C, Mandich A, Magill-Evans J, Young NL, et al. Advancing rehabilitation research: An interactionist perspective to guide question and design. Disabil Rehabil. 2006;28(19):1169–76.
2. Colquhoun H, Leeman J, Michie S, Lokker C, Bragge P, Hempel S, et al. Towards a common terminology: A simplified framework of interventions to promote and integrate evidence into health practices, systems, and policies. Implement Sci [Internet]. 2014;9(1):51. Available from: http://www.implementationscience.com/content/9/1/51
3. Popovic MR, Kapadia N, Zivanovic V, Furlan JC, Craven BC, McGillivray C. Functional electrical stimulation therapy of voluntary grasping versus only conventional rehabilitation for patients with subacute incomplete tetraplegia: A randomized clinical trial. Neurorehabil Neural Repair [Internet]. 2011;25(5):433–42. Available from: http://nnr.sagepub.com/cgi/doi/10.1177/1545968310392924
4. Stucki G, Grimby G. Organizing human functioning and rehabilitation research into distinct scientific fields. Part I: Developing a comprehensive structure from the cell to society. J Rehabil Med.2007;39:293–8.
5. Tanaka S, Hanakawa T, Honda M, Watanabe K. Enhancement of pinch force in the lower leg by anodal transcranial direct current stimulation. Exp Brain Res. 2009;196(3):459–65.
6. Domingo A, Ferris DP. Effects of physical guidance on short-term learning of walking on a narrow beam. Gait Posture [Internet]. 2009 Nov;30(4):464–8. Available from: http://linkinghub.elsevier.com/retrieve/pii/S096663620900201X
7. US Department of Human Health and Services. Research plan for the National Center for Medical Rehabilitation Research. Washington, DC; 1993.
8. World Health Organization. International classification of functioning, disability and health: ICF. 2001.