How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR's Rehabilitation Engineering Research Centers.

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a "total approach to rehabilitation", combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970's, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program.

Guyanese Women's Experiences of Invisibility in Health Care in England.

This article explores the opportunities for strengthening participatory action research (PAR) through an intersectionality framework. In 2015, I completed a Ph.D. study into the lived experiences of migrant Guyanese women, living in England, when seeking diagnoses and treatment for Type 2 diabetes. Group storytelling acted as a lens for the women to talk about how they tried to obtain a diagnosis, in addition to their migratory experiences. Both PAR and intersectionality encourage participant collaboration and community engagement of oppressed groups. The article concludes that the PAR study would have been enhanced by overlaying it with an intersectionality framework. The argument is presented that by doing so the women's accounts in the research study would have been privileged more and activism encouraged in bringing about change to current practices and avoiding perpetuating existing oppressions. The Ph.D. study methodology was based on Koch's interpretation of PAR. In this, PAR is used where the focus is on participation of all stakeholders toward reform and change. It is seen as a social, practical and collaborative process where building relationships with participants is crucial. Intersectionality acknowledges the potential for "black" and other women of color to not remain on the margins but to challenge the traditional biomedical model of health care delivery. Implementing an intersectional approach to the data generation and analysis would have acknowledged power dynamics (i.e., privilege and oppression) and help to identify potential gaps in diabetic provision which are currently invisible or inequitable due to interventions designed to meet the needs of a homogeneous White middle class society.