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 ![[----------------Horizontal Rule----------------]](/webart/hrule.gif){kind=small}  Article 5. The IRV Hoensbroek, The NetherlandsOn April 26 and 27, 1994 the IRV (Institute for Rehabilitation, Development and Knowledge Transfer in the Fields of Rehabilitation and Handicap) celebrated its 12th anniversary and the opening of its new building. I was invited to participate in a two-day symposium commemorating these events. The theme "Transitions: Visions On Near Future Developments in the Field Of Rehabilitation" symbolized IRV's moving from one building to another as well as changes in the rehabilitation field. Three main areas were addressed: Assessment, Treatment and Intervention Programs. Kurt Johnson's6 keynote speech focused on transition in rehabilitation as an evolving phenomenon occurring within cultural contexts (society, family, health-care system.) He described a dynamic relationship among assessment, treatment and outcomes. He encouraged ethnographic approaches and a vertical integration of services. Respondents7-9 raised several additional points: The Decade of the Brain is an initiative declared in 1990 in the US and followed by the European Union (EU) and by several European countries, including the Netherlands. The brain, as an organ, has much more plasticity than has been recognized up until now. Imaging techniques show right hemisphere brain activity in patients with good recovery from aphasia after a left hemisphere stroke. Thus, notions of restitution, substitution and compensation of function are central to a discussion of the rehabilitation process. "Support needed from society to reach an acceptable quality of life differs enormously from one patient group to the other." Increasingly, "great demands are placed on the user, which can only be achieved by a few." Technology. Margita Lundman's10 inspiring keynote speech visualized a vast Transit Hall of Technology. In this hall she pictured a Competency Development Gate, a Horizon Widener Gate and an Emerging Technologies Hall. She said, "Look upon disability as a normal variation of human existence and assistive technology as a means for people to lead a good life." She encouraged consideration of ethical questions as we "apply" assistive technology to people with disabilities. Mathis Soede 11 gave his perspective on assistive technology markets and the manufacturing industry in Europe. He said without certain political decisions at national and EU levels and commitments to research and development efforts, the development of EU products for export can fail. Respondents12-13 discussed contributions of mainstream technology and a growing market for assistive technology as the world's population ages. Discussants agreed there was a need for more user involvement in research and development and for more effective and efficient ways of exchanging information. Service Delivery. Service delivery issues pervaded the conference. In my keynote speech, 14 we used an analogy of a canal system with locks to visualize barriers and transitions confronted by persons with disabilities and stakeholders in the rehabilitation process. Service delivery always occurs within a broad socio-political context with inherent economic constraints. Our challenge is to demonstrate successful outcomes, best practices, benefits and costs, effective use of assistive technology and the dynamic need for information exchange. Luc de Witte 15shared results from a comprehensive study of service delivery systems for the provision of technical aids in the European Union. He related his observations to current practices and future directions in Europe. Respondents 16-17 emphasized the unique realities and characteristics of each country in the EU and the difficulty of creating systems that are effective, decentralized, high quality and user influenced. The final session gave consumer perspectives on topics covered during the symposium. 18-21 Using a computer with a speech synthesizer, Greg Filz18 emphasized the importance of user input into all aspects of the process. Other speakers talked about the importance of providing a continuum of options for persons with disabilities tailored to meet their needs rather than the needs of institutions, companies or professionals. Also discussed was the role of legislation at national and international levels. For example, Filz pointed out that today in the EU, national legislation "literally stops handicapped people at national borders."
This article appears in ACN Volume 7, # 3. You may order this issue by clicking on Ordering Home Page Online Ordering 
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