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For many years rehabilitation workers have looked with despair at the severely disabled. Their need for rehabilitation was obvious, but their handicaps were so forbidding that they tended to squelch even the boldest hopes. Some believed the severely handicapped were hopeless, while others thought something could be done, but they weren't quite sure what. To answer this question, and to test the belief of possibility, the California Division of Vocational Rehabilitation launched a program in 1955 to rehabilitate a group of severely disabled persons. With the help of federal funds, a broad, liberal, exploratory study was set up.

"Man's venture into the darkness of the unknown often is preceded by the glimmer of a light which may only exist as an idea."

These are the words that introduce the report on the California study. They are pertinent words, for the problems and possibilities of rehabilitating the drastically handicapped have long been enveloped in the darkness of ignorance. It was into this darkness that the counselors participating in the program penetrated the light of their hope and ideas shining them on the most challenging cases. Free rein was given their imagination, and the results were inspiring, living tributes to their creativity.

Each of the counselors was assigned to a different rehabilitation center, with assisting medical and para-medical personnel. They worked with 254 persons with severe disabilities between the ages of 16 and 44. Vocational goals were not specific or limited, but a vast spectrum considered and evaluated. If one idea didn't work, another was tried. There were few restrictions on imagination, services, or expenditures.

The results were astounding. Of this heretofore "hopeless" group, 100 were rehabilitated. This definition included those who became capable home-makers or simply partially self-supporting. On the study follow-up 12 to 18 months after the cases had been closed as rehabilitated, the average earnings of the clients were $81 weekly. The maximum pay was $220 a week, and the minimum $5. Fifty-six per cent of those contacted had been promoted within eighteen months.

There were other interesting conclusions from the study. For instance, the most important attribute of the severely handicapped client in achieving rehabilitation is motivation. Not adjustment, acceptance of paralysis, or emotional maturity as popularly theorized, but the client's willingness to use his remaining capabilities to accomplish something.

The most important quality for the counselor was the ability to see things not as they were but as they could be. This imaginative vision is also essential in the client. It is especially beneficial in determining what mechanical devices might make the client more productive and independent. If the counselor or client can define a problem and set up specifications for the solution, even a handyman or local mechanic can build the needed item. It was found that mechanical assistive devices make it possible for many to perform competitive tasks.

It was also concluded that the attractiveness of equipment and assistive devices was important. If the client refused to wear or use an ugly, bulky brace or device, it would be of little benefit. This confirmed what the severely disabled had known all along, that we persist in being human with all the accompanying vanities and foibles of that state.

Assistive and adaptive devices frequently decide the success or failure of rehabilitation. One typical difficult problem in modification of devices was the vocational need of one man to use a tape recorder simultaneously with a telephone. Both instruments had to be operated with knee movements because the client's upper extremities were completely paralyzed. When a satisfactory set-up was established, this man was prepared to handle a magazine subscription agency.

This particular problem, and many more, were solved through the imaginative mind of Mr. A. G. Garris, one of the counselors on the project. Mr. Garris's interest in the severely disabled is profound and sincere, and he has extended a generous offer to help any GAZETTE readers who have mechanical assistive problems. He states that he can usually give help to enable the handicapped person to tackle the problem in a way that will give desired results. Stressing that he is not an electronic expert, he requests that any letters seeking mechanical assistive help contain as much information as possible. He suggests reading the letter to an intelligent listener and then incorporating the listener's questions in the letter. Address Mr. A. G. Garris, Dept. of Rehabilitation, 107 South Broadway, Los Angeles, California 90012.

Mr. Garris also reveals that there are 150 copies of this report, which he will send free to any severely disabled reader requesting one. Send requests to the above address. You will find many ideas and much information about the rehabilitation of the severely handicapped in this report.

Not surprisingly, analysis of clients' jobs shows a preponderance of activities that can be performed individually. The list of jobs handled by the severely disabled is impressive. It includes psychologist, teacher, librarian, manicurist, sewing machine operator, telephone dispatcher, television technician, bookkeeper, and many more. These actual results prove the potential and employability of the drastically disabled.

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On the average, it takes about 29 months to rehabilitate a severely disabled client. It is expensive in time and money. The costs for the first two years of the project were $284,295.76. At times complete families were involved in the impact of a client's illness, requiring the coordination of many social agencies and special services. Marriage failures caused repercussions in all areas, postponing the beginning of the rehabilitation process.

Home environment is exceedingly important in the rehabilitation of the severely disabled. The home that is well-equipped to care for the client promises to continue as a stable, functioning unit. Neglect in considering those who care for the client can destroy the best vocational plans.

Another optimistic finding of the study was that every client benefited in some way from the rehabilitative efforts. The 145 who did not achieve employment gained in self-care, better home care, or greater and happier self-acceptance.

The method of rehabilitating the severely disabled was made evident in the study. Needed was proximity to a metropolitan area where a complete evaluation could be made by a team of experts and where there would be available specialized rehabilitation facilities, training, and job opportunities; well-functioning home environment; adequate self-care; a rehabilitation goal based on established work tolerance; suitable training; and modifica-tion of the work area and types of duties performed. Shorter hours of work are often necessary. Maintenance medical care may be required. Rehabilitation services must be brought to the client. All the principles of selective placement need to be applied when rehabilitation services are completed. Energy needed for vocational employment must be conserved by making hone care as efficient as possible. And then, anything is possible!

One of the case studies in the report is a typical example of rehabilitation success. A woman almost totally paralyzed by arthritis required constant attendance for feeding, personal care, and transferring back and forth from bed to chair. Among her limited assets was a gregarious, pleasant personality, and it was decided this could best be utilized with a telephone answering service.

The rehabilitation agency arranged for a ten-line key cabinet with toggle switches instead of plugs to be installed by the phone company. The cabinet was placed on a hospital-type over-bed table, to be operated from her wheelchair during the day, and from her electric Gatch-type bed at night. She could raise herself by using a specially built switch to handle night calls. The agency arranged a zoning change, helped her obtain a business license, provided answering service tutoring, and invited various organizations to contribute services and money.

The result was that this woman eventually cleared a profit of $1500 a month with her telephone answering service. Total expenditure was $3,242.72. Total return to the community was estimated at $85,000 in gross earnings.

The successes and innovations described in this report were derived from one study into rehabilitation of the severely disabled. Another federal grant has been requested by the same agency for a planning program to expand upon the findings of this study. It is now felt that it has not been only the formidable cost of serving the severely disabled that has allowed them to be overlooked, but the lack of knowing how to serve them. As indicated by the 1965 Amendments to the Vocational Rehabilitation Act, these obstacles have been recognized and are thus on the way to being overcome. The first filters of light are opening the darkness. The beam of rehabilitation has expanded to include all handicapped persons, and to this development we say, "Welcome!"