deeply concerned with the development of an adequate program in my native city of Philadelphia now. And I think we are now making progress in this direction.

I believe that the same concept should apply to the rehabilitation facility as to the workshops. And so did our medical advisory committee. And, therefore, we want to suggest that under the statement on workshop improvement and workshop grants a change in the wording be made and that we should say, "workshop and rehabilitation center improvement grants."

We believe under the statement of workshop technical assistance to workshops that it might be well to say "technical assistance to work shops and rehabilitation centers."

We believe that on the two committees that are proposed within this legislation that there should be on the National Policy and Performance Council and on the National Commission on Architectural Barriers at least one handicapped individual. We believe, however, that this should not be spelled out in the law, but that it be the legis lative intent to indicate that it would be wise to have one handicapped individual on each of these two commissions, and that that would be a very wise move.

The CHAIRMAN. If you would not write it into the law, you would put it into the committee report?

Dr. KRUSEN. I would hope so. I would think that if it was indicated as the legislative intent, then appropriate action could be taken without complicating the picture by making it a part of the law.

I am concerned with the handicapped blind people as well as with the physically handicapped. I became a member of the board of the National Institute for the Blind. And one of the blind men mentioned as an architectural barrier something that I would not have thought of, and I am sure that no person who was not blind would have thought of. He said that one of the great handicaps was the stop signs, of an octagonal shape, which were often so located and so low that a blind person hit his head against the sign and that the sharp corner would cut his head. A blind man could pick out architectural barriers in serving on this Commission very effectively; the paraplegic in his wheelchair has special problems that he can explain to the Commission more effectively than we who are not so handicapped.

On the Medical Committee of the American Rehabilitation Foundation we are especially in favor of the research and computer program. We feel, as Dr. Spencer does, that the establishment of computer techniques to provide for more adequate exchange of ideas and for more adequate determination of the numbers of persons who are handicapped and the numbers who can be rehabilitated and so on is of tremendous importance. And all of the modern medical research is becoming more and more dependent on computer techniques in more effectively dealing with our research programs.

We thought, perhaps, that the special programs and comprehensive planning to expand vocational rehabilitation services in which it is mentioned that a maximum annual grant to any State would be $50,000 was perhaps a little low, and that perhaps $100,000 would be more significant as a figure for the States as the maximum annual grant.

With regard to the chance to study these handicapped people for periods of 6 to 18 months-18 months for the mentally retarded particularly with the provision that the Secretary of Health, Education, and Welfare might apply this to certain other groups I think is an extremely important measure so far as we who are trying to rehabilitate the seriously disabled medically are concerned.

I think, for example, of a patient of mine, and I think sometimes one example is important and helpful to a committee-a patient of mine who came to me very early in our rehabilitation program at the Mayo Clinic where I was at that time, 20 years ago, was a man named Jacobson. He had dived into a shallow pool and had broken his neck. He had fractured his seventh cervical vertebra and he was paralyzed from the neck down and he was told that he was completely incapacitated, that he would have to spend the rest of his life in the hospital in bed being cared for by others. When he came to us in the early stages of our rehabilitation program we said that we would try to do what was possible to help him and to make a long story short, it took us almost a year to get him where he could get around strapped up in a wheelchair and move his chair. And this man today runs a magazine business which nets him some $11,000 a year. He is the Mark Evans of a little town in Minnesota and has his own radio program from his own wheelchair at home and he has a real estate business and he is completely self-sufficient and independent and he is a quadriplegic without any motions in his lower extremities and just a little motion in his hands. He has to be lifted out of bed. He has a railing which carries him from his bed to his bathtub. He is dropped into his bathtub. He is hoisted into a wheelchair and yet he is completely self-sufficient and supports himself entirely.

This is what can be done now when we have 6 to 18 months for evaluation in this kind of comprehensive rehabilitation program that is being developed here under the measures so well prepared by the Vocational Rehabilitation Administration.

I am going to leave to Dr. Ellwood the picking up of certain points with regard to this bill which I may have overlooked. We believe that this particular measure can be a great step forward which is comparable to the legislation contained within the act of 1954, and I think it is the most significant bill on rehabilitation for the handicapped that has been introduced since the original legislative action of 1954.

Dr. Spencer mentioned these handicapped people were hidden in the back bedrooms. And this is so very, very true. I have tried to think of ways in which to bring to the public a comprehension of the plight of these 3 million handicapped people in this Nation. And I hit upon the idea of letting us suppose that there was a huge national calamity, and let us say that these 3 million people were disabled in a single day in one huge disaster. This would be looked upon as a great national calamity. And all of the Nation would turn out in force to serve these 3 million handicapped people. Well, this is just as much of a calamity as would be such a holocaust, and there are these 3 million people who are handicapped and who should be served and can be served much more effectively by the legislation which is presented in S. 1525.

Senator YARBOROUGH. Will you pardon me for interrupting? The Senate is in session, and I must go to the floor. I want to say that

I agree with your recommendations about the $50,000, that the limitation should be raised to $100,000 Five percent of these 3 million people from my own State would mean about 115,000 people would have an inability to work or a reduced ability to work and as shown in these tables, that would be about 7,000 and $50,000 for them, it seems to me would be too modest a sum when we consider the problems of each State. Thank you.

Dr. KRUSEN. I am glad that you agree. In closing I would like to stress the importance of the combined medical and vocational rehabilitation centers in order adequately to serve the handicapped of this Nation. These two must go forward hand in hand. I should like particularly to pay a tribute to Miss Switzer and her dedicated staff. I had the privilege of serving as Special Assistant for Health in the Medical Affairs a few years ago in this Vocational Rehabilitation Administration's office and I know of the dedication of this small and hardworking group of public servants.

Senator HILL. You mentioned that this was a humanitarian effort and this is a point that I have tried to stress again and again. In my opinion there can be worse things than death. And it may be much more humane to save a person from years of dependency than merely to save his life. And we as physicians and workers with the sick and in vocational rehabilitation have a real service to doa real humanitarian contribution to make in saving these people from years of dependency.

The CHAIRMAN. Thank you, Dr. Krusen.

We will be pleased to hear from you now, Dr. Ellwood.

STATEMENT OF DR. PAUL M. ELLWOOD, EXECUTIVE DIRECTOR, AMERICAN REHABILITATION FOUNDATION, MINNEAPOLIS, MINN.

Dr. ELLWOOD. Mr. Chairman and members of the committee. It is a great pleasure and honor to appear before you and your subcommittee, Senator Hill. It is a pleasure because we are always treated in such a courteous and interested and sympathetic fashion.

It is a particular honor this year when so much legislation of critical significance and importance to health is emerging from this committee. I refer to the medical complex bill, the proposed changes in professional and educational assistance and today to the very significant amendments to the VRA programs.

I would like to speak today as a medical doctor. I am delighted to testify on behalf of this basic rehabilitation proposal because as Dr. Spencer and Dr. Krusen have said, vocational rehabilitation and medical rehabilitation are one, and one cannot move forward without the other. This legislation today will be of special importance to the severely disabled.

In our institution, the Kenny Institute, we are now admitting five new patients with stroke each week.

The CHAIRMAN. Five each week?

Dr. ELLWOOD. Each week, yes. And most of these are younger people-men in their fifties. It takes us from 2 to 3 months to determine whether or not these individuals indeed can return to work.

With paraplegics and quadriplegics we find it requires around 6 months to fully rehabilitate these individuals medically. These are

a very special group of people. Among the 20 paraplegics and quadriplegics in the Kenny Institute now there is only 1 man over 25 and only 1 young lady. All of the rest are young men between the ages of 17 and 25, with their whole life ahead of them, who have been injured in accidents of one kind or another.

The facility staffing section of this bill is a very important provision. We have seen too many facilities become bogged down in the early financial problems that confront any new agency of this type. They simply find themselves so overwhelmed by financial problems that they fail to offer the quality of services that their clients and patients need.

Under the excellent workshop improvement section of this bill workshops will be given a much needed opportunity to analyze and improve their business management-because workshops are really small businesses. They must operate with a minimum of professional staff, and the bulk of their employees are individuals with marginal skills who are being prepared for competitive employment. The small business needs every bit of business know-how possible to survive in the competitive market.

We would also like to punctuate the idea of supplying to these workshops consultants in management and other fields. There are no consulting groups at present who are available for relocation facilities and workshops.

All of us in this field are called upon from time to time to visit this or that center to give advice on how to operate their programs, but these consultations are rather casual, last a day or so, and are not satisfying from the standpoint of detailed planning and application, to either those who give the advice or those who receive it.

This legislation will encourage the development of groups who can devote themselves completely to consulting and planning and providing first-rate management advice.

I want to address myself to the proposal for a National Commission on Architectural Barriers. This is a superb idea. There has been far too little emphasis put on this problem. The vast majority of buildings are inaccessible to disabled people. There are certain booby traps that everyone who lives in a wheelchair looks for, such as hotel and gas station restrooms. They are impossible to get into on wheelchairs Courthouses and churches with their magnificent expanses of steps leading up to them constitute a tremendous barrier to getting in and out of them. But there is another kind of architectural barrier that might be referred to as a situational architectural barrier where the attitude or the lack of training of the individual that the disabled person confronts, constitutes a barrier a human barrier, if you will I mean the restaurant where the head waiter promptly ushers the man in a wheelchair to a back table where he will not clog the aisle, or the airline that does not know how to mechanically handle the wheelchair or handle the individual who is in it. And the theater where the seats and aisles are too narrow for wheelchair patients.

On the other hand, there are some beautiful examples around the country now of institutions and companies that have become well informed on this problem and are doing a superb job. At the University of Illinois every building in the university has now been made accessible to the individuals living in a wheelchair.

The CHAIRMAN. They have such a building program? Dr. ELLWOOD. Right. They have made very definitive efforts to correct this problem there. It is a favored place now for disabled individuals to go to school.

And I refer next to the Tyrone Guthrie Theater which has just been developed in our State where the whole ushering staff and architects met with our rehabilitation nursing staff to learn how to handle patrons in wheelchairs in the theater. I have seen all kinds of fan letters they have received from disabled individuals complimenting them on their expert handling of the problems. On their seating ticket application there is a little notation, "Special seating arrangements available for individuals in wheelchairs."

United Air Lines also does a superb job of handling individuals in wheelchairs. I have traveled with people in wheelchairs and have found that this airline has a wheelchair waiting at the bottom of the ramp as soon as the door to the airplane is opened. I do not know how they get them out so rapidly.

If a genuine effort is made, these architectural barriers can be eliminated, and certainly this Commission on Architectural Barriers is a sound approach to call attention to this problem and to mount some good demonstration projects.

Finally, I would like to address myself to the research and information section of this bill. An internal research and information

program is long overdue. A corps of scientists who can effectively work with scientists in the outside community is essential to any Government agency engaged in any significant amount of research and educational activity. It makes available to them a different type of person who can communicate well with scientist grantees.

We are also very pleased to see this information section in here. Much more elaborate criteria will need to be developed, for describing the outcome of rehabilitation. It is not enough to say that the client is handicapped and that he was employed. Other factors must be taken into account. There must be taken into account the budget, how severely disabled he has been, how long he has been out of work, what kind of job did he get, how long did he keep it, how much money and time was required to rehabilitate him.

When you begin working with information of this complexity applied to hundreds of thousands of individuals, only the most elaborate computer system setup can tabulate and analyze, store, and retrieve such information.

So this seems an essential component of this bill, and certainly one which we commend to your attention.

Senator Hill and Senator Kennedy, we are very grateful for this opportunity to appear before you today and we hope that this subcommittee will give careful consideration and support to this very important legislation.

The CHAIRMAN. Senator Kennedy.

Senator KENNEDY of Massachusetts. I would like to commend you and to express my appreciation for the fact that you are here. I regret that I was unable to hear the complete scope of your testimony, but it seems to be worth while in the ideas that you have presented and I want to express my own appreciation to you.

The CHAIRMAN. I want to say that this subcommittee is grateful to both of you. We deeply appreciate your presence here today.