The following excerpt is taken from Chapter
of Life on Wheels: For the Active Wheelchair User, by Gary Karp,
copyright 1999, published by O'Reilly & Associates, Inc.
To order, or get more information about Gary's book, call
(800) 998-9938. Permission is granted to print and
distribute this excerpt for noncommercial use as long
as the above source is included. The information in this
article is meant to educate and should not be used as an
alternative for professional medical care.
A primary goal of rehab is for you to be able to work, if at all possible. Rehab
staff want to foster your opportunity to return to your previous or some other
kind of job. The anticipation of returning to a productive role in the world can
increase your motivation to participate in rehab.
You will work with a vocational counselor--sometimes known as vocational
rehabilitationist--who might be employed by the rehab center, assigned by the
insurer, or hired as a contractor by your State Vocational Rehabilitation
agency. Vocational Rehabilitation (Voc Rehab) is a government program that
exists at both state and federal levels. Legislation dating as far back as 1917
has authorized money to help injured workers get back to work. Your insurer
might also have vocational rehab services and funds to offer you. If you get
back to work, they figure you will not require as much expensive continuing
healthcare or long-term disability benefits.
Counselors you work with will have varying loyalties, depending on who
employs them. Those loyalties can limit their effectiveness, as attorney,
quadriplegic, and disability activist Deborah Kaplan of the World Institute on
The Voc Rehab system is sometimes helpful, often not. And very frustrating, very
bureaucratic, very rigid. These days, they don't want to spend much money per
client. You have to be a fairly sophisticated user of government entitlement
services to get anywhere with rehab, unless you happen to luck into a good
counselor who is genuinely trying to facilitate life. Counselors usually want to
put you into a community college, get you a trade and say that they
rehabilitated you. If you get a job, they have succeeded, whether you keep it or
The hard truth is that your State Voc Rehab agency will generally work with
you only when they consider you employable. How that gets defined might be up to
the particular case worker you encounter. This man with advanced muscular
I went to their office, did the entire intake process, interviewed with a case
worker, but nothing ever came of it. They said they would call me, but never
did. I talked to other disabled people more familiar with the workings of the
California rehab system, who told me the reason they probably didn't follow up
is because they considered a person with MD in his late thirties a "bad
risk." That is, I would probably die before I would work enough to make the
money spent on me worth it. As cold as this may sound, I believe it to be true.
I've heard about this type of thing many times before.
State Vocational Rehabilitation services are getting tighter these days.
There has been greater demand on these programs, in part due to the increasing
number of repetitive strain injuries resulting from computer use in offices. In
some states, legislation limits the money that can be spent for a given
case--this limited amount can be small if you need an education and adaptive
tools such as a computer or a modified vehicle.
You always have the chance to advocate for yourself. For instance, you don't
have to accept the first counselor who is assigned to you. If there is someone
in the rehab facility to organize your vocational rehab, she might work harder
on your behalf because she has no association with the funding source. When a
counselor is doing her job well, she does the following:
- Takes a history of your past job experience and skills
- Learns about your medical status and prognosis
- Considers how your disability affects your ability to return to previous
- Evaluates new career possibilities and make suggestions to see what
interests you, if your previous work is not possible
- Surveys the job market to help identify realistic options
- Explores sources and means of funding, if you require training or
- Coaches you on job seeking and interview skills
- Advises you and your employer on possible modifications and accommodations
that make it possible for you to perform the job
Vocational counselors want to make the most of your physical and
psychological rehabilitation, accomplished with hard work by you and the rehab
team. They want to make a smooth transition to work or to education, and take
best advantages of your accomplishments in rehab.