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The Dembo-Wright Lecture provided a forum to discuss how innovation occurs in general and in rehabilitation psychology. The 21st Century will rely upon the creation and enhancement of knowledge. Universities, industries and professional disciplines are challenged to develop models that nurture their development of knowledge jobs that create new systems or products. A new model of nurturing innovation: The Rainforest, relies upon creating ecosystems that bring together and support the critical groups allowing instances that propel spontaneous growth of sustainable enterprises. Over the last 3 decades, rehabilitation psychology has seen disruptive-yet productive-innovation when thought leaders in the field have introduced ideas that move the discipline to entirely new areas of discussion. For rehabilitation psychology, consideration of new models of practice that address the huge needs of the developing world are warranted. The complexity of nurturing innovation in differing environments must be addressed. Progress to date indicates that understanding and defining the interface between machines and humans will be critical to the future of rehabilitation psychology. (PsycINFO Database Record

PURPOSE Changes in the health care environment have brought challenges and opportunities to the field of psychology. Practitioners have been successful in modifying service models to absorb losses of financial support for behavioral health care, due to managed care and public policy changes, while simultaneously managing the growing need for these services. However, in this reactive mode of responding to evolutions in the health care system, the field of psychology has at times lost sight of the long-term vision required to promote psychology's inclusion in the health care system of the future. In particular, a focus on training psychologists and ensuring the availability of funding to support these activities must be a priority in planning for the future. This article provides an overview of federal programs that currently offer funding for psychology training, as well as other opportunities for federal funding that have been unrealized. Details regarding advocacy efforts that were required to secure available sources of funding are given, followed by consideration of strategies for taking advantage of existing resources and prioritizing advocacy for additional funding. CONCLUSION Funding for psychology training provides an avenue for increasing the number of well-trained psychologists who can serve patients' mental and behavioral health needs and thereby improve health outcomes. Moreover, capitalizing on available funding opportunities for psychology training and promoting efforts to expand these opportunities will help ensure that the field of psychology is positioned to remain an important contributor to the health care system of the future.

The US Congress faces a host of health issues that demand immediate attention. Many of these issues are of considerable importance to those persons with spinal cord injury (SCI), including the rising cost of health care and health insurance, the current budget shortfalls facing state governments, and the need for a Medicare prescription drug program. Persons with disabilities are becoming increasingly dependent on public forms of insurance, like Medicare and Medicaid, and are bearing a disproportionate share of service curtailment. Other issues relevant to persons with disabilities and health care providers are prospective payment reimbursement implementation for rehabilitation, the reauthorization of the Rehabilitation Act, and the New Freedom Initiative. Considering the political climate and the importance of such issues, the need for advocacy among professionals and consumers is greater than ever.

Return to work following spinal cord injury is achievable for many individuals. Interdisciplinary rehabilitation teams are ideally suited to facilitate an individual's efforts at overcoming the numerous barriers involved in returning to gainful, competitive employment. Many of these barriers are person-specific (i.e., education level), and multifaceted assessment and comprehensive vocational planning are suggested. Other barriers, such as economic disincentives and poor access to needed services, are less easily overcome. Rehabilitation professionals are encouraged to become familiar with recent health and disability policy (i.e., Americans with Disabilities Act) and become proactive in policy formation. There is a significant need for development and testing of model programs to enhance return to work for individuals with spinal cord injury.

Neuropsychological assessment is a standard procedure for rehabilitation patients with cognitive dysfunction. However, the use of neuropsychological evaluations in rehabilitation settings is limited as the most commonly used measures were originally developed for diagnostic purposes with an emphasis on localization/lateralization of lesions and description of brain-behavior relationships. As a result, the functional (versus diagnostic) utility of neuropsychological evaluations is questionable at best. Furthermore, neuropsychological evaluation in rehabilitation settings will continue to be of limited utility as long as INS-APA Division 40 guidelines continue to emphasize training in neurologic and neuroanatomic factors, with minimal attention to rehabilitation issues and resources. Several factors necessitate the use of neuropsychological evaluations for functional rather than diagnostic purposes, including advances in neuroradiological evaluation, the growth of rehabilitation facilities given increased survival rates for brain injured patients, and an associated greater need for psychological services for these patients. Suggestions are offered for improving the functional utility of neuropsychological evaluations, as well as more effective ways to train neuropsychologists in rehabilitation issues and interventions.

Managed care has affected the delivery of services in all health care sectors, although its impact on rehabilitation has been slower to take effect. These changes have required clinicians to provide more efficient services that are demonstrated to have an impact on functional outcome. However, in order to be reimbursed for specific rehabilitation services, such as cognitive rehabilitation, it is necessary for clinicians to become more knowledgeable regarding managed care, service delivery, and reimbursement issues. This article describes the impact of managed care on health care in general and on rehabilitation specifically. In addition, current billing procedures and reimbursement issues as they relate to cognitive rehabilitation are discussed, and suggestions for ways to secure reimbursement are presented for all disciplines providing cognitive rehabilitation services.

Rehabilitation medicine represents a substantial area of growth in the healthcare industry over the course of the last two decades. Historically characterized by collaborative, interdisciplinary team approaches and the inclusion of family members in treatment, rehabilitation medicine targets restoration of functional abilities in individuals with debilitating illness or injury. Interestingly, systems /biopsychosocial frameworks that have been incorporated into other areas of medicine have been underutilized in the rehabilitation context. Systems theory and biopsychosocial approaches to rehabilitation medicine appear to have considerable value and utility in this field, particularly in light of current and proposed healthcare reform. We argue that the systems perspective, which has enjoyed success in the area of family systems medicine, can be further extended into the rehabilitation context. A systems perspective as applied to the rehabilitation setting is provided in the present article, and recommendations are made for increased involvement by systemstrained professionals from clinical, re

Head injury constitutes a significant public health concern. Despite increasing recognition of the morbidity and mortality associated with head injury, there exist few statewide estimations of the prevalence and public perception of head injury. Knowledge of the public's perception can facilitate the funding and planning for the treatment and rehabilitation of persons with head injury. This study was undertaken for this purpose by the Missouri Head Injury Advisory Council and consisted of a stratified sampling of 1123 Missourians in a statewide telephone poll. The results revealed that the general public has an accurate perception of head injury and that knowledge improved as a function of direct experience with head injury.

Individuals sustaining spinal cord injury often display initial distress followed by relatively effective coping allowing effective participation in rehabilitation. For those patients who continue to display significant symptoms of subjective distress or objective behavioral disturbance, behavior management interventions may help the individual cope with the demands of rehabilitation. A range of intervention strategies, drawn from many theories of behavior are needed to address the range of problems that occur. In the approach described in this article, traditional behavior modification programs, recruitment of family, and patient-community meetings are considered as behavior management strategies. Those strategies are considered with respect to three broad areas of behavioral disturbance: (1) problems of attitude, (2) disorders of mood, and (3) disturbances of character. Behavior management is conceptualized as a method of affirming the patient's autonomy, independence, and self-determination. Suggestions are made regarding program development.

Legislative advocacy is a prerequisite for the development of research and community services benefiting individuals with traumatic brain injury (TBI). Dr Mitchell Rosenthal and other leaders in rehabilitation began the process of advocating for TBI services more than 25 years ago, before many in the field fully appreciated the necessity of these efforts. Since that time, substantial gains have been made through advocacy efforts on behalf of individuals with TBI and their families. This article provides an overview of the TBI advocacy movement, highlighting federal legislation resulting in appropriations for TBI services and protecting the rights of individuals with TBI. Key government entities engaged in developing states' TBI infrastructure and providing services to individuals with TBI and their families are also discussed. In addition to celebrating some of the successes that were initiated by the efforts of Dr Rosenthal and other visionaries, select shortcoming of current legislation is noted to provide insights regarding future advocacy needs.

Examined the relation of hope to occupational burnout among 81 nurses in chronic-care rehabilitation units. Hypothesizing from Snyder's (1989) model of hope in the reality negotiation process, it was predicted that hope would be significantly predictive of three separate components of burnout. Nurse burnout was assessed with the Maslach Burnout Inventory (Maslach & Jackson, 1981). Separate regression equations revealed higher levels of hope to be signficantly associated with lower emotional exhaustion and depersonalization, and greater personal accomplishment

Diagnosing mood disorders in chronic illness is problematic. Under-standing the value of individual symptoms in predicting depression is one approachto this problem. The contribution of individual symptoms to the diagnoses of majordepressive disorder (MDD) was examined in 82 patients with confirmed rheuma-toid arthritis (RA) and a control sample of ISO university employees. Comparisonsbetween DSM-HI and DSM-EQ-R rates of MDD were derived using the Inventoryto Diagnose Depression (IDD). It was found that cognitive-affective symptomssuch as dysphoric mood, acknowledgment of guilt, and suicidal ideation were themost efficient predictors of MDD. According to DSM-IH-R criteria, 16% of the RAsample met criteria for diagnosis of MDD, while 27% of the R A sample met criteriaaccording to the DSM-1H. RA patients reported that their arthritis affected theirmood at least occasionally. Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease thataffects approximately 1% of the population (Zvaifler, 1988). In addition to thepain and physical disability that are principal features of the illness (Potts,Weinberger, & Brandt, 1984), a variety of psychological factors has beenidentified as concomitant to disease(Anderson, Bradley, Young, McDaniel, W Frank et al., 1988; Rimon, 1974; Rimon & Laakso, 1984;Zaphiropoulos & Burry, 1974).The assessment and diagnosis of depression in RA has been questioned onclosely interrelated, conceptual, and methodological grounds. First, the few earlystudies citing the prevalence of depression in RA (e.g., Bishop et al., 1987;Zaphiropoulos & Burry, 1974) utilized instruments that were not designed todiagnose depression. These instruments contain many somatic items that arecommon to both depression and chronic illness (Turk, Rudy, & Stieg, 1987).Researchers in these studies typically have used self-report instruments such asREHABILITATION PSYCHOLOGY Vol. 36, No. 4,1991

Spinal Cord Injury, J. Scott Richards et al Limb Amputation, Bruce Rybarczyk et al Traumatic Brain Injury, Mitchell Rosenthal and Joseph Ricker Stroke, Bruce Caplan and Steve Moelter Geriatric Issues, Peter A. Lichtenberg and Susan E. MacNeill Neuromuscular and Musculoskeletal Disorders in Children, Dennis C. Harper and David B. Peterson Brain Injuries, David R. Patterson and Greg R. Ford Multiple Sclerosis, Gerald M. Devins and Zachary Shnek Chronic Pain, Daniel M. Doleys Hearing and Vision Loss, Robert Q. Pollard, Jr. et al Psychiatric Rehabilitation, Gary R. Bond and Sandra G. Resnik Functional Status and Quality of Life Measures, Allen Heinemann Assessment of Psychopathology and Personality in Persons with Disabilities, Cynthia L. Padnitz et al Evaluating Outcomes Research - Statistical Concerns and Clinical Relevance, Mary J. McAweeney Neuropsychological Assessment, Tim Conway and Bruce Crosson Forensic Psychological Evaluation in Rehabilitation, Brick Johnstone et al Patients with Brain Tumors, Marc W. Haut et al Paediatric Neuropsychology, Janet E. Farmer and Laura Muhlenbruck Alcohol and Traumatic Disability, Charles H. Bombardier Postacute Brain Injury Rehabilitation, James F. Malec and Jennie L. Ponsford Neuroimaging and Rehabilitation Outcome, Erin Bigler Rehabilitation Based on Behavioural Neuroscience, Edward Taub and Gitendra Uswatte Disability and Vocational Behaviour, Edna Mora Symanski Injury Prevention, Frank A. Fee and Dawn A. Bouman Social Support and Adjustment to Disability, Kathleen Chwalisz and Alan Vaux Caregiving in Chronic Disease and Disability, Richard Shewchuk and Timothy R. Elliott Social Psychological Issues in Disability and Rehabilitation, Dana S. Dunn The Disability and Rehabilitation Experience - an African American Example, Faye Z. Belgrave and S. Lisbeth Jarama Prospective Payment Systems, Kristopher J. Hagglund et al Education in Rehabilitation and Healthcare Psychology - Principles and Strategies for Unfiying Subspecialty Training, Robert L. Glueckauf Ethics in Rehabilitation Psychology - Historical Foundations, Basic Principles and Contemporary Issues Stephanie L. Hanson et al Drawing New Horizons for Rehabilitation Psychology, Timothy R. Elliott and Robert G. Frank.

Although depression has been widely studied among persons with spinal cord injury, the ubiquitous and unsophisticated use of the term and presumptions about its manifestations in the rehabilitation setting have needlessly encumbered the understanding and treatment of depression. Major themes and issues in the study, measurement, and treatment of depression among persons with spinal cord injury are reviewed. Greater precision is recommended in distinguishing diagnosable depression from displays of negative affect, anxiety, distress, and dysphoria. Correlates of depressive behavior among persons with SCI are surveyed, and guidelines for research and practice in the SCI setting are explicated.

Depression frequently is diagnosed in persons with chronic illness or following the onset of disability. The overlap of symptoms of many chronic illnesses and disabling conditions with depression may lead to an overestimation of depression in such populations. Some investigators have proposed revised criteria for diagnosing depression in these conditions without an understanding of the contribution of diagnostic criteria in disabling conditions. This study investigated the nature of depressive symptom criteria constellations by individually factor analyzing the Inventory to Diagnose Depression (based on DSM-III diagnostic criteria) in spinal cord injury (n = 134), rheumatoid arthritis (n = 78), student (n = 140), and community (n = 150) groups. A four-factor solution emerged, with the first factor labeled "dysphoria" being represented by symptoms of negative self-evaluations, depressed affect, and suicidal ideation. The results indicate that a core element of the syndrome of depression is dysphoria, which suggests that the contribution of somatic items may be less important to the identification of the depressive syndrome in chronic illness.

Adjustment to spinal cord injury has traditionally been assumed to be accompanied by depression. Yet contemporary research has failed to support this view and has provided evidence that depression is maladaptive in rehabilitation and adjustment. This paper reviews and integrates this literature. Methodological and theoretical perspectives are discussed. Recommendations for future research are proposed, and implications for clinical practice are addressed.

The present study examined the effects of depression and time since injury upon interpersonal response to spinal cord injury. In Experiment 1, 93 undergraduates listened to a scripted audiotape interview of an actor portraying a spinal-cord-injured individual who was either depressed or not depressed and had been injured for 1 or 4 years. In Experiment 2, 60 professional rehabilitation staff members listened to the same tapes. After listening to the depressed tape, students were dysphoric and rated the depressed actor as less attractive, competent, and desirable. Staff members reported more hostility and rated the depressed actor as less attractive. Staff members who regularly worked with victims of head injuries were more depressed after listening to the depressed tape than were staff members who cared for spinal cord injuries or other patient groups. Time since injury was not a significant factor in either students' or staff members' responses.

In an attempt to replicate a recent report of the factorial structure of the Multidimensional Health Locus of Control Scale, a sample of rehabilitation patients (N = 107) were studied. Analyses in the present study failed to validate the previously reported three-dimensional structure, which indicates a need for careful interpretation of this scale when used with certain populations. An alternative factor structure and possible future directions are proposed.

This article describes the development of the Brain Injury Rehabilitation Scale (BIRS), a 20-item scale rating attention, memory, cognition, goal-directed behaviour, social interaction, and adjustment to injury. The BIRS was designed to provide ratings of clinical progress during post-acute rehabilitation from the perspective of the patient, the family and the treating staff. The BIRS was administered to two groups. Group one included five patients in a post-acute rehabilitation programme who were administered the BIRS each week for the 24 weeks of the programme. Group two was a control group composed of 21 college students. The BIRS was administered to each control subject for three consecutive weeks. The BIRS was found to be a sensitive and reliable measure of rehabilitation progress. Inter-rater reliability was high. Further evaluation of the BIRS is warranted.

Previous studies examining the role of age in the mediation of psychological response to a catastrophic injury, such as spinal cord injury, have yielded equivocal results. To further examine the role of age in the response to catastrophic injury, 53 patients with spinal cord injury were administered a battery of tests assessing life stress, depression and general psychological functioning. Two groups were derived from negative ratings of life events and subject's age. Younger patients, who reported higher levels of life stress, also reported more depressive symptomatology; younger patients with lower levels of life stress reported fewer depressive symptoms. Both young and old patients with high stress reported higher levels of depressive symptomatology. Psychological disturbance was greater in the high life stress group as indicated by significant elevations on the global severity index of the Symptom Checklist-90 and elevations on somatization, obsessive compulsive, interpersonal sensitivity, depression, anxiety and psychoticism subscales. Age effects were not found for the Symptom Checklist-90.