Rehabilitation Research Articles

Arthroscopic acromioclavicular joint resection

Distal clavicle resection has been an effective procedure for treatment of acromioclavicular arthritis. The conventional open surgical technique involves deltoid detachment and reattachment, which may cause postoperative weakness and requires protection during the postoperative period to allow for healing. Arthroscopic acromioclavicular joint resection has the theoretical advantages of no deltoid disruption and a shorter rehabilitation period. The purpose of this study was to compare open versus arthroscopic acromioclavicular joint resection in a laboratory setting. The goals of acromioclavicular joint resection in this study were to remove 5 mm of the medial acromion and 10 mm of the distal clavicle. Acromioclavicular joint resections were performed on 10 cadaver shoulders (5 open resections and 5 arthroscopic resections). Open resection was successful at 10 of 15 distal clavicle locations and 14 of 15 medial acromial locations. Arthroscopic resection was successful at 14 of 15 distal clavicle locations and 10 of 15 medial acromial locations. The combined bone resection averaged 14.8 mm (+/- 1.99 mm) for the open technique and 14.8 mm (+/- 2.58 mm) for the arthroscopic technique. The combined bone resection was 1.5 cm or more in all of the measured locations for the open technique and in 14 of 15 measure locations for the arthroscopic technique. There was no statistically significant difference between the two groups. In the laboratory setting, acromioclavicular joint resection was performed effectively and predictably with arthroscopic instruments. Arthroscopic bone resection was comparable to open bone resection.

A prospective, randomized study of three surgical techniques for treatment of acute ruptures of the anterior cruciate ligament

Treatment of ACL tears is controversial. Recent reports on nonoperative treatment have shown poor results. Results after primary repair have deteriorated with time, leading to augmentation procedures that seem to have improved the results. However, there have been few prospective, randomized studies in this field. Our goal was to compare primary repair with a bone-patellar tendon-bone augmentation method and with a new method using the Kennedy Ligament Augmentation Device. One hundred fifty patients aged 16 to 50, all of whom had acute ACL tears, were randomized with the closed envelope method to one of three groups treated with open surgical methods. Fifty patients were treated with primary repair, 50 patients with patellar tendon augmentation, and 50 patients were augmented with the Kennedy Ligament Augmentation Device. All patients were operated on within 10 days of injury. The rehabilitation protocol was identical, consisting of a long leg cast for 2 weeks, followed by a brace with no weight-bearing and limited motion for 6 weeks. The patients were followed prospectively by one surgeon (LE) using the Lysholm functional score, Tegner activity level score, clinical evaluation and KT-1000 arthrometer at 6 months, 1, and 2 years. Three patients were lost to followup. There was no age or activity level difference between the groups. Sport activities led to 85% of the injuries, with skiing, soccer, and European handball representing 80% of injuries. All three groups reduced their activity level the 1st year. The repair group remained at the same level after 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)

The conservative treatment of the anterior cruciate deficient knee

Seventy-nine recreational athletes (average age, 26 years) with complete ACL tears were treated with nonligamentous arthroscopic surgery, monitored rehabilitation, functional bracing, and activity modification. The average followup was 52 months (range, 36 to 102 months). Six (8%) patients ultimately underwent ligament reconstruction and were considered failures of nonreconstructive treatment. The remaining 73 patients were the subject of detailed analysis. There were 9 (11%) excellent, 25 (32%) good, 17 (22%) fair, and 28 (35%) poor results. Although 71 patients (97%) were satisfied with their knee for activities of daily living, only 36 (49%) were satisfied with their knee for sports. Twenty-nine (40%) had significantly modified their athletic activities. Age, sex, interval from injury to treatment, associated meniscal tears (49 or 67%), and articular cartilage damage (21 or 29%) had no apparent effect on the outcome. Poor results were noted in 29 (40%) patients with significant pivot shifts. Multiple repeat injuries, repeat arthroscopy, isokinetic deficits, and increased length of followup were also associated with poor results.

The patient with symptomatic chronic anterior cruciate ligament insufficiency. Results of minimal arthroscopic surgery and rehabilitation.

Forty-nine patients with 51 chronic symptomatic anterior cruciate deficient knees were studied retrospectively by chart review and follow-up examination an average of 5.8 years postinjury and 1.5 years from arthroscopic evaluation, with or without arthroscopic surgery, and the institution of a conservative rehabilitation program. Subjective evaluation of function was obtained by questionnaire. At arthroscopy, meniscal lesions were seen in 37 of 51 knees, and degenerative changes were noted in 24 knees. The ACL was absent in 43 knees. Partial meniscectomy or suturing was performed on 20 patients. All patients had an average of 3 weeks of supervised physical therapy stressing hamstring strengthening. At followup, thigh girth measurements of injured and normal legs found thigh wasting in 40 patients. Seven of 33 patients radiographed showed evidence of degenerative changes. About two-thirds of the patients returned to some level of athletics and had no problems with activities of daily living. Twenty were able to return to pivoting sports, but only five could return to their preinjury levels of competition. Of the 18 patients who did not return to athletics, only 8 were considering or had had a ligament reconstruction. Those patients who chose to continue rehabilitation beyond the prescribed period and who modified their activities had a better functional outcome.

Risks and Benefits of Peripheral Arterial Reconstructions in Octogenerians

The purpose of this study is to analyze the real benefit of peripheral arterial reconstructions of very old patients in relation to the underlying risk in terms of hospital mortality, long-term survival, amputation rate and level, grade of reha bilitation, and relief of symptoms. In this retrospective analysis, 120 patients with an average age of 85 years were evaluated, 224 peripheral arterial recon structions, repeat-operations, and amputations having been performed. Limb salvage was the leading indication for surgery in 93% of all patients, disabling claudication in only 7%. Twenty-one patients (18%) died in the hospital, 65 (54%) survived the opera tion for an average of 2½ years, and 34 (28%) are still alive at the end of the observation period; 34 (28%) required amputations and 65 (54%) improved; 81 patients (69%) were ambulant on discharge from the hospital, 68 (79%) in the group without amputation but only 13 (38%) in the amputated group. This study comes to the conclusions that more than half of the octogenerians benefited from peripheral arterial reconstructions, that the risk of arterial re constructions is acceptable even in this poor-risk group of patients, and finally that arterial reconstructions should be tried whenever feasible to improve the old patient's chance for rehabilitation.

Tracheo-Innominate Artery Fistula: Successful Surgical Repair Using a Portion of the Thymus as an Arterial Wrap

A 40-year-old postcraniotomy patient was undergoing comprehensive reha bilitation at our hospital when he suddenly had massive bleeding from a tra cheo-innominate artery fistula that complicated a low tracheostomy. Successful surgical repair was achieved with an arterial wrap fashioned from a portion of the thymus. To our knowledge, this technique has never been used before.

Attitudes Towards Disability and Rehabilitation Among Political and Professional Leaders in Israeli Development Towns

The process by which development towns were created in Israel engendered the need for welfare and rehabilitation services for a varied population. The present ex ploratory study focussed on the opinions of two groups of persons who supposedly represent and direct the social services in their communities — political leaders and professional leaders. A sample of 120 local leaders in ten development towns in northern Israel were individually interviewed on their attitudes towards disability and rehabilita tion, based on an original questionnaire. The results indicated several problems in attitudes towards disability and rehabilitation that can be seen as characteristic of local leadership, and possibly of the general population in Israeli development towns.

A stroke unit in a district general hospital: the Greenwich experience.

Strokes are the commonest cause of severe permanent physical disability in Britain,1 and their care consumes a considerable proportion of acute medical resources. The reported incidence in Britain varies,2 3 but 150 cases per 100 000 a year is a useful approximation for planning. In some areas about 40% of patients with stroke are admitted to hospital2-4 with some evidence that they are more physically disabled than those left at home.5 Between one-third and one-half of the patients admitted to hospital will die within the first three weeks,2 6 and of the survivors, about one-quarter will be confidently independent, one-half will be able to walk independently using an aid and have limited personal independence, and one quarter will remain heavily dependent, usually confined to bed or chair.6 7 The care of patients with stroke may be arbitrarily but use fully divided into an acute care investigative phase and a re habilitation phase. We agree with Mulley and Arie8 that this first phase is best managed in hospital. Though uncommon, treatable lesions are more likely to be recognised in hospital, and the sheer effort needed and the difficulties that arise in managing at home a semiconscious or severely paralysed patient who initially may be incontinent should be recognised. In many general hospitals patients with stroke are admitted under the care of general physicians, and this acute care/investigative phase is accepted as being part of general medicine and is dealt with competently. The level of interest in the rehabili tation phase is unfortunately likely to be lower. As the hard

Violent Crime: Prediction and Control

Violent crime has become a major public concern, threatening many citizens' sense of well-being and involving tremendous national social and economic costs. The various professions involved in the study, rehabili tation, and control of violent offenders feel increasing public pressure to protect society from crimes of violence, primarily by incapacitating the offender. Decisions to incarcerate or release offenders are often based on in dividual predictions of future violent behavior. Recent public policy con cerning career offenders represents an attempt to protect society by evaluating collective probabilities of future violent behavior. This paper examines the growing concern over violent crime, the prediction techniques that have been used to determine the disposition of an offender, the tendency toward overprediction documented by various research studies, and recent public policies enacted to curb crimes of violence. Finally, balancing individual rights and the rights of society in light of public attitude and public policy involves several moral and ethical questions. 1. President's Commission on Law Enforcement and Administration of Justice, The Challenge of Crime in a Free Society (Washington, D.C.: U.S. Govt. Printing Office, 1967), p. 18. 2. "Losing Battle against Crime," U.S. News and World Report, Dec. 15, 1974; "Crime in America: One Nation's Journey into Fright," PTA Magazine, April 1974; "Crime Wave," Time, June 30, 1975. 3. Robert Winslow, ed., Crime in a Free Society, 2d. ed. (Encino, Calif.: Dickenson, 1973), p. 157. 4. James Q. Wilson, Thinking about Crime (New York: Basic Books, 1975), p. 7. 5. Winslow, Crime in a Free Society, p. 156. 6. Ibid., p. 48. 7. James Brooks, "The Fear of Crime in the United States," Crime and Delinquency, July 1974, pp. 242-43. 8. Winslow, Crime in a Free Society, p. 157. 9. Ernst A. Wenk, James O. Robison, and Gerald W. Smith, "Can Violence Be Predicted?" Crime and Delinquency, October 1972, pp. 393-402. 10. Wilson, Thinking about Crime, p. 21. 11. Don Gottfredson, "Assessment of Methods," in Crime and Justice, Vol. 3, Leon Rad zinowicz and Marvin Wolfgang, eds. (New York: Basic Books, 1971), pp. 362-63. 12. Michael A. Peszke, "Is Dangerousness an Issue for Physicians in Emergency Com mitments?" American Journal of Psychiatry, August 1975, p. 828. 13. Edwin H. Sutherland and Donald R. Cressey, Principles of Criminology (Philadelphia: Lippincott, 1960), p. 135. 14. Jonas R. Rappeport, ed., The Clinical Evaluation of Dangerousness of the Mentally Ill (Springfield, Ill.: Charles C Thomas, 1967), p. 27. 15. Alfred J. Kahn, "Public Policy and Delinquency Prevention," in Crime and Justice, Vol. 3, Radzinowicz and Wolfgang, eds., p. 417. 16. Sheldon Glueck and Eleanor Glueck, Predicting Delinquency and Crime (Cambridge, Mass.: Harvard University Press, 1960), pp. 144-49. 17. Gottfredson, "Assessment of Methods," p. 347. 18. Daniel Glaser, The Effectiveness of a Prison and Parole System (Indianapolis, Ind.: Bobbs- Merrill, 1969). 19. Elmer H. Johnson, Crime, Correction and Society (Homewood, Ill.: Dorsey Press, 1966). 20. Gottfredson, "Assessment of Methods," p. 360. 21. Winslow, Crime in a Free Society, p. 161. 22. John P. Conrad, Crime and Its Prevention (Berkeley, Calif.: University of California Press, 1970). 23. Daniel Glaser, "The Efficacy of Alternative Approaches to Parole Prediction," American Sociological Review, June 1955, p. 284. 24. Daniel Glaser, "A Reconsideration of Some Parole Prediction Factors," American Sociological Review, June 1955, p. 335. 25. Wenk et al., "Can Violence Be Predicted?" pp. 395-98. 26. Harry L. Kozol, Richard Boucher, and Ralph Garofalo, "The Diagnosis and Treatment of Dangerousness," Crime and Delinquency, October 1972, pp. 371-92. 27. John Monahan and Lesley Cummings, "Social Implications of the Inability to Predict Violence," Journal of Social Issues, March 1975, p. 153. 28. Ibid., p. 155. 29. Ibid. 30. Ibid., p. 153. 31. Kozol et al., "Diagnosis and Treatment of Dangerousness," p. 373. 32. Monahan and Cummings, "Social Implications of the Inability to Predict Violence," p. 374. 33. Norval Morris, "The Future of Imprisonment: Toward a Punitive Philosophy," Michigan Law Review, May 1974, p. 1162. 34. Ibid., p. 1169. 35. Ibid., pp. 1165-66. 36. Ibid., pp. 1169-70. 37. Wenk et al., "Can Violence Be Predicted?" p. 402. 38. Monahan and Cummings, "Social Implications of the Inability to Predict Violence," pp. 160-61. 39. Sutherland and Cressey, Principles of Criminology, pp. 590-91. 40. John Irwin and Lewis Yablonsky, "The New Criminal: A View of the Contemporary Offender," in Crime in America: Perspectives on Criminal and Delinquent Behavior, Bruce J. Cohen, ed. (Hasco, Ill.: F. E. Peacock, 1970), pp. 199-200. 41. Timothy D. Schellhardt, "Experimental Program Musters Legal Forces against Repeat Offenders to Boost Convictions," Wall Street Journal, Aug. 19, 1976, p. 28. 42. Gresham M. Sykes, Crime & Society (New York: Random House, 1967), p. 194. 43. Schellhardt, "Experimental Program," p. 28.

Factors in Successful Job Training and Job Performance of the Disadvantaged

The purpose of this study was to determine characteristics of the disadvantaged client and of the Concentrated Employment Program (CEP) which related to the successful vocational training and placement of 150 unemployed recipients who were served by the San Antonio Concentrated Employment Program. The general method was to compare the disadvantaged clients who were successful at on-the-job training that led to employment with those clients who did not complete such training and were not placed. Thirty predictor variables were categorized into the following sets of characteristics: personal, academic, economic, vocational, and CEP. Only academic and vocational client characteristics contributed significantly to the prediction of successful training and place ment. The conclusions indicated that rehabilitation personnel should carefully interview for educational and vocational information when selecting clients for training and placement and that remedial programs as the CEP should programatically help clients to better academic achievement. It is also important that clients experience success in vocational placement since a successful vocational history and academic achievement predict future success at training and placement. THE STATE/FEDERAL VOCATIONAL Rehabilitation Program has devoted much of its energies since 1968 to the rehabilitation of the public assistance or disadvant aged client. Disadvantagement is certainly a multifaceted concept. No simple definition is universally accepted. Ayers (1) sums up a definition of the disadvantaged as those persons who are handicapped in translating their potential into self-fulfilling economic and social roles because of de velopmental deficits which are manifest in several kinds of deprivation?namely, educational, cultural, economic, social, psychological, vocational, and physical. The movement to rehabilitate the disadvantaged is a demanding one, for various reasons: (a) the number of the disadvantaged are many; (6) the social ills from which they suffer are extraordinary (7); and (c) their rehabilita tion involves a greater consideration of the disadvantaged environment in which they live (3). However, the traditional concepts of do not adequately describe the client. It en compasses more than victims of trauma, disease, or con genital disorders, and must assume an examination of the client's deprived environment which operates to render him in the face of an economy and labor market which require skilled and trained personnel. Kunce (4, 5) and other rehabilitation scientists have called for research that systematically records and deter mines characteristics of the disadvantaged or otherwise disabled client that relate to success and failure at rehabil itation and employment. Systematic assessment would be useful in establishing expectancies for the client and in subsequently modifying the program as necessary. Gorden (2) adheres to the theme of systematic client assessment to determine appropriate program goals and indicates that most research projects have failed to identify crucial var iables which would contribute to the rehabilitation success of clients. In order to evaluate the effectiveness of a pro gram, it would appear then that these variables would have to be identified for a particular disability group. The purpose of the present study was to determine characteristics of the disadvantaged clients and of the Concentrated Employment Program which related to the successful training and placement of 150 clients who were served by this rehabilitation program in San Antonio. The general method was to compare the disadvantaged clients who were successful at on-the-job training that led to employment with those clients who did not complete on the-job training and were not placed.

Shifting Perspectives in Drug-Abuse Policy

Beginning with the passage of the Narcotic Addict Rehabili tation Act in 1966, federal drug abuse policy has shifted sig nificantly, in attempts to find alternatives to the traditional punitive model. NARA represented the emergence of a planned, incremental, treatment-centered model for federal offenders. With the advent of the Nixon Administration "law and order" theme, drug policy shifted to a social-control model emphasizing methadone maintenance in local govern mental units as a means of containing street crime. In 1972, Public Law 92-93 authorized a relaxation of the legislative restrictions on NARA and provided greater flexibility in the treatment of federal offenders, including probationers, parolees, and those mandatorily released. Subsequent legisla tion passed by Congress in 1972-73 reflected a desire to merge the treatment-centered model with the social-control model. This paper analyzes these policy trends and raises questions about implications for the administration of justice.

The Need for Professional Education in Probation and Parole

While we know a great deal about the practice of probation and parole and about their place in the correctional process, we know virtually nothing about the kind of professional education that is best suited for probation and parole work and we have little information on the extent to which graduate-level opportunities are available. This article re- examines the tasks of probation and parole officers and relates them to the differing academic programs used by such personnel. Data from a na tional survey are used to demonstrate that probation and parole agencies have not supported Professional staff development. A number of ap proaches to improve graduate study for probation and parole officers, at both the agency and the university level, are described. Implementing these suggestions would help to attain the objectives of effective rehabili tation and higher professional status for community correction.

Drugs and Public Health: Issues and Answers

Since shortly after the turn of the century, drug abuse in the United States has been defined and treated, at least in part, as a public health issue requiring the intervention and services of the federal government. Thus, over the years the government has developed a broad spectrum of specialized agencies and activities to deal with the drug problem. These range from the creation of a "Narcotics Farm" in 1935 to the establishment of the National Institute on Drug Abuse in 1973; from the study of mari huana use and its effects to the sponsorship of narcotic antagonist research; from the training of professional and paraprofessional treatment and rehabilitation personnel to the conduct of multi-modality field trials of heroin addict rehabili tation programs. Clearly, the principal weakness in the national public health approach to narcotic addiction and drug abuse lies in the area of primary prevention, particularly as it is directed to high risk adolescents. The intent of this paper is to highlight some of the drug abuse activities and accomplishments of the National Institute of Mental Health within the Public Health Service of the Department of Health, Education and Welfare; to examine some of the significant issues and demands of the national drug program in recent years; and to indicate the directions that have been pursued in an effort to find solutions to drug abuse problems.

St. Leonard's House

The Joint Commission on Correctional Manpower and Training found that many agencies are now using ex-offenders in roles usually performed by professionals. This phenomenon is generally accepted as a positive contribution to the rehabilita tion process. The current task, however, is to learn how to inte grate this service with long-term benefits for the individual.

The treatment of thrombophlebitis without anticoagulation: report of five cases.

Five patients with active thrombophlebitis diagnosed by signs and symptoms, and confirmed by thermograms and venograms, were admitted to Moss Reha bilitation Hospital, Philadelphia, Pennsylvania. They all had relative or abso lute contraindications to anticoagulation (gastrointestinal and genitourinary bleeding, and deep decubitus ulcers). They were not treated by the conventional means of bed rest, warm soaks and elevation of the involved extremity. The treatment consisted of a full rehabilitation program, including range of motion, transfer and ambulation exercises. They were fitted with anti EM stockings, and the extremities were elevated when at rest. The goal in treating thrombophlebitis should be early resolution of the condi tion, and prevention of pulmonary embolism. Bed rest leads to venous stasis, predisposes the patient to extension of the thrombus and increases the incidence of thromboembolism. Therefore, patients were mobilized immediately. Elastic stockings and elevation of the extremity have also been shown to increase venous flow, leading to a decrease in the formation and extension of the throm bus, and to a reduction of the threat of thromboembolism. There was no evidence of thromboembolism in the five cases. Thus, an active program of exercise and ambulation, in addition to anti EM stockings and elevation of the extremity when at rest, is worth considering, even though thrombophlebitis has occurred and anticoagulation is contraindicated. This is especially true in a rehabilitation program where ambulation is a significant goal. Experiences with larger numbers of such patients would help to confirm this impression.

Toward a Rational Doctrine of Rehabilitation

Rehabilitation is seen, essentially, as a reorientation of the offender toward society's values. The delinquent is distinguished by an inner conviction that his way is right and that of society wrong. All effective correctional theories must take this as their point of departure. An integrated approach to offender rehabili tation is necessary, and the impact of the criminal justice system from the moment of arrest must be studied from the point of view of its effect on the offender's attitudes. Conduct can be affected only through accord or coercion, but the latter, influenc ing the offender to retain his antisocial values, produces no permanent benefit to society. Prison, as long as it is thought of as punishment, is inconsistent with the therapeutic goals of reha bilitation. Rehabilitation is not a lesson to be taught but rather one to be learned by each individual. The system must provide the conditions to make such learning possible. There is no uni versal recipe for rehabilitation. Treatment must be geared to individual needs and this requires a radical rethinking of dis posal methods. Rehabilitation is seen as another term for re- education embracing all aspects of the offender's attitude toward society, as something akin to a religious conversion; it demands of society a just conduct in all its dealings with the offender at all levels of processing.

A Voucher System for Correction

As an alternative to coerced programs of in-prison rehabilita tion that are designed and implemented by administrators, a voucher system is proposed in which prisoners would be given wide discretion in designing and purchasing their own rehabilita tion programs. Problems of implementing and evaluating the proposal are discussed.

Participation in medical undergraduate training by the department of rehabilitation medicine.

PARTICIPATION IN MEDICAL UNDERGRADUATE TRAINING BY THE DEPARTMENT OF REHABILITA TION MEDICINE WILLIBALD NAGLER, M.D., F.A.C.P.* Why Should Rehabilitation Medicine Be Taught! The student of medicine should acquire knowledge about the incidence and nature of the more common disorders of the locomotor system and should become acquainted with the main physical methods used to ameliorate these disorders. Besides drugs or surgery, patients afflicted with such ailments often require exercise therapy, guidance, and sometimes mechanical devices to lead a life of maximal independence from the physical assistance of another person. These disorders are frequently long lasting, and familiarity with them enables the student to gain insight into the effect of these ailments on the patient's attitude toward the family and the community. The special skills which rehabilitation medicine ought to teach are those of the evaluation of the locomotor system. By the nature of its clinical work, rehabilitation medicine lends itself to introducing the student to the particularities of long-term care. Likewise, it can show the part which physical rehabilitation procedures play in limiting disabilities. The future physician should also be introduced to the various techniques used to forestall pulmonary and musculoskeletal complications after surgery or during acute illness. A student will also encounter patients suffering from neuromuscular disorders. From these disorders the necessity of planning for a patient's optimal way of life can be learned. Attitude of the Medical Student toward Medical Rehabilitation In this aspect, a department of rehabilitation medicine has much to offer. The student will become aware that a realistic approach to * Associate professor of medicine, Cornell University Medical College, and head, Department of Rehabilitation Medicine, New York Hospital-Cornell Medical Center, 525 East 68th Street, New York, New York 10021. Perspectives in Biology and Medicine · Spring 1973 | 457 rehabilitation goals has to be adopted to secure some success. A rehabilitation department abounds with possibilities of demonstrating teamwork with physical and occupational therapists, nurses, social workers, orthotists, and bioengineers. The student will encounter rehabilitation care at home, in the hospital, and in the nursing home. The needs and wants of the individual patient can be contrasted with those of the family and the community at large. Awareness of preventive measures which limit and arrest disability can be taught by patient follow-up. Rehabilitation medicine offers many examples for the teaching and practice of pattern recognition, which, in a way, is a computer habit of thought. In addition, rehabilitation medicine is frequently concerned with patients whose disabilities call for an attitude of problem solving, not only by the process of scientific reasoning but as frequently by the balance of probabilities. When Should Rehabilitation Medicine Be Taught? The point of time at which a medical student should be introduced to the clinical practice of rehabilitation medicine is open to debate. Our past educational experience with summer trainees showed that a good anatomical and physiological knowledge is necessary for the student to function effectively as a member of the rehabilitation team and derive some benefit from his participation. To give the student the opportunity to acquire some skill in the evaluation of locomotor disability, a certain period of supervision has to be provided in his curriculum. Frequently more than one body system is involved in patients who require rehabilitation therapy. This calls for, eventually, interdepartmental teaching efforts. Members of other specialty departments may have to be called upon. Rehabilitation also offers many opportunities to apply well-established neurophysiological principles in daily practice, as, for instance, muscle fiber recruitment. During the third and fourth year of the curriculum some provisions ought to be made for faculty members whose sphere of interest is in rehabilitation to offer their views to the future physician. This could be done along with teaching sessions in the various fields of clinical medicine. Rehabilitation medicine is particularly amenable to investigative activities by medical students. Medical personnel below the M.D. and Ph.D. level, as bioengineers, therapists, and social workers, make substantial contributions to the practice of clinical rehabilitation. 458 I Willibald Nagler · Rehabilitation Medicine in Medical Training How Should Rehabilitation Medicine Be Taught? Rehabilitation medicine should be allowed to contribute to the student's education at various times and...

Correctional Policy

This article points up the need to study the assumptions that underlie correctional administration and to examine correctional change processes systematically. The nature of correctional goals and the different ways they may be classified are described. The authors argue that the offender's motivation of behavior within the system is an important criterion in classifying goals. The change strategy typology of Herbert Kelman is described, and the change agent's modes of compliance, identification, and internalization are related to specifically correctional concerns. Using these change strategies as a base, the authors develop and describe four models of correctional policy: reform, rehabilita tion, reintegration, and restraint. The results of administering a policy questionnaire are reported, with the conclusion that perception of policy may be quite different at various levels in a correctional organization. The relationship between correc tional policy and correctional research is discussed.

Slang Usage in the Addict Subculture

The drug addict lives in a unique world, differing even in its language, a new jargon. Possibly nothing more clearly illustrates the fact that drug addiction has cultural components than the special communication among its members. This special argot plays an important role in the society of the drug user by pro viding in-group cohesion and communication. Until the advent of large numbers of juveniles into the outer fringes of the addict subculture, little was known of this unique language except by police and persons specializing in the rehabil itation of the addict. The juveniles picked up much of the slang and put it into popular usage. Through the facilities of the police departments of large cities throughout the United States, a glossary of current slang usage was compiled and is included in this article.