[Federal Register Volume 62, Number 90 (Friday, May 9, 1997)]
[Notices]
[Pages 25760-25770]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-12259]
[[Page 25759]]
_______________________________________________________________________
Part VII
Department of Education
_______________________________________________________________________
National Institute on Disability and Rehabilitation Research; Notice of
Funding Priorities for FY 1997-1998; Office of Special Education and
Rehabilitative Services, Notice Inviting Applications for New Awards
Under Certain Programs for Fiscal Year 1997
Federal Register / Vol. 62, No. 90 / Friday, May 9, 1997 / Notices
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DEPARTMENT OF EDUCATION
National Institute on Disability and Rehabilitation Research;
Notice of Final Funding Priorities for Fiscal Years 1997-1998 for
Research and Demonstration Projects, Rehabilitation Research and
Training Centers, and a Knowledge Dissemination and Utilization Project
AGENCY: Department of Education.
SUMMARY: The Secretary announces final funding priorities for the
Research and Demonstration Project (R&D) Program, the Rehabilitation
Research and Training Center (RRTC) Program, and the Knowledge
Dissemination and Utilization (D&U) Program under the National
Institute on Disability and Rehabilitation Research (NIDRR) for fiscal
years 1997-1998. The Secretary takes this action to focus research
attention on areas of national need to improve rehabilitation services
and outcomes for individuals with disabilities, and to assist in the
solutions to problems encountered by individuals with disabilities in
their daily activities.
EFFECTIVE DATE: These priorities take effect on June 9, 1997.
FOR FURTHER INFORMATION CONTACT: David Esquith. Telephone: (202) 205-
8801. Individuals who use a telecommunications device for the deaf
(TDD) may call the TDD number at (202) 205-2742. Internet: David__--
Esquith@ed.gov.
SUPPLEMENTARY INFORMATION: This notice contains final priorities to
establish R&D projects for model systems for burn injury and traumatic
brain injury, RRTCs for research related to aging with a spinal cord
injury and severe problem behaviors, and a D&U project to improve the
utilization of existing and emerging rehabilitation technology in the
State vocational rehabilitation program.
These final priorities support the National Education Goal that
calls for all Americans to possess the knowledge and skills necessary
to compete in a global economy and exercise the rights and
responsibilities of citizenship.
Note: This notice of final priorities does not solicit
applications. A notice inviting applications under these
competitions is published in a separate notice in this issue of the
Federal Register.
Analysis of Comments and Changes
On March 4, 1997, the Secretary published a notice of proposed
priorities in the Federal Register (62 FR 9886-9892). The Department of
Education received ninety-four letters commenting on the notice of
proposed priorities by the deadline date. Seventy-eight additional
comments were received after the deadline date and were not considered
in this response. Technical and other minor changes--and suggested
changes the Secretary is not legally authorized to make under statutory
authority--are not addressed.
Research and Demonstration Projects Program
Priority 1: Burn Injury Rehabilitation Model System
Comment: The Burn Injury Rehabilitation Model System projects
should provide care from the point of injury to the completion of care.
Discussion: The projects are intended to provide care from the
point of injury to the completion of care. The priority is not as clear
as it could be on this point.
Changes: The initial purpose statement of the priority has been
revised to require a project to provide care from the point of injury
through community integration and long-term follow-up.
Comment: The 1992 Burn Model system's final priority excluded
children. The new projects should provide care to children and adults.
Discussion: The 1992 final priority discussion of the exclusion of
children from the Burn Model system's program stated, ``The burn injury
model system will be developed initially to serve and collect data on
adults since NIDRR's experience with the model systems for spinal cord
injury and traumatic brain injury projects indicates that these systems
can be successful with adults. The model systems can be adapted for
children later.'' (57 FR 57284). The commenter is correct, and the Burn
Model System program should be able to include children without
jeopardizing the database or service delivery progress that has been
made to date.
Including children will require the Burn Model System projects to
address new and unique issues, such as the effect of the burn injury on
physical, cognitive, and social development. It will also demand that
the projects coordinate with children's service providers, including
special educators. The annual funding of the Burn Model System projects
has been increased in order to provide adequate support for the
additional tasks that will result from this change.
Changes: The background statement and the priority have been
revised to require the projects to include children in the model system
and the projects' research and demonstration activities. The fourth
purpose statement has been revised to include special education
interventions and education outcomes.
Comment: The model system projects should be required to use
electronic communication.
Discussion: The use of electronic communication is so common that
it is unnecessary to require it.
Changes: None.
Comment: What guidelines have been established for defining the
cost of care data from the data which are more commonly available,
i.e., charges of care?
Discussion: There are no guidelines for defining cost of care.
Applicants have the discretion to propose how they will define cost,
and the peer review process will evaluate the merits of the definition.
An applicant could propose to define cost as charges of care.
Changes: None.
Comment: A comment in response to the TBI Model System proposed
priority questioned the use of the term ``multidisciplinary'' to
describe the model system. The commenter opined that the manner in
which care is rendered in most, if not all, the model systems is in an
``interdisciplinary'' or ``transdisciplinary'' fashion.
``Interdisciplinary'' or ``transdisciplinary'' should be used instead
of ``multidisciplinary.''
Discussion: This comment, although not addressed to the proposed
Burn Injury Rehabilitation Model System priority, applies equally to
it. The term ``multidisciplinary'' was used to convey that the projects
should involve all necessary and appropriate disciplines in the
delivery of care. Since there are no universally accepted definitions
of any of these terms, use of any one term could lead to a
misunderstanding.
Changes: The term ``multidisciplinary'' has been deleted from the
Burn Injury Rehabilitation Model System priority, and the priority
requires the projects to involve all necessary and appropriate
disciplines in the delivery of care.
Priority 2: Traumatic Brain Injury Model Systems
Comment: The priority limits inclusion in the model systems
database to patients who are admitted to a participating trauma unit
and then transferred to a participating acute rehabilitation hospital
for inpatient services. This limitation excludes patients who, after
participating in a trauma unit, receive services at alternative post-
acute treatment sites such as a skilled nursing facility, a subacute
rehabilitation facility, or at home. Increasingly, managed care
[[Page 25761]]
organizations and rehabilitation providers are utilizing these excluded
treatment sites. These exclusions should be eliminated from the
priority in order to allow the projects to study the impact of these
alternative treatment pathways.
Discussion: This recommendation raises fundamental questions about
the purpose and future directions of the TBI Model Systems program. As
indicated in the background statement, ``NIDRR's multi-center model
systems program is designed to study the course of recovery and
outcomes following the delivery of a coordinated system of care
including emergency care, acute neuro-trauma management, comprehensive
inpatient rehabilitation, and long-term interdisciplinary follow-up
services.'' Including other pathways of post-acute treatment such as
skilled nursing facilities, subacute rehabilitation facilities, and
home care would significantly change the nature of the model system
that has been in place for since 1987. This change would require
projects to engage in data collection activities from a wider range of
treatment sites, and possibly a wider range of severity of brain
injury. The nature and quality of services provided at these
alternative treatment sites, as well as the population served, may vary
significantly, and this variation would need to be addressed in the
compilation of the national database.
Post-acute treatment of TBI is going through a period of
transition, and it is necessary for the TBI Model system program to be
equally dynamic in order to maintain the program's relevance. In order
to facilitate a smooth transition, the priority is being changed to
provide applicants with the option of expanding their scope of
activities to include alternative post-acute treatment sites while
maintaining the requirement that all projects include the current
pathway of inpatient rehabilitation treatment. This change is made with
the acknowledgment that complications may occur. For example, if some
projects expand to include alternative post-acute treatment sites,
while others maintain the current treatment pathway, the uniformity of
the database will be affected. These complications should be outweighed
by the new information that will be generated about the post-acute
alternative treatment sites. In addition, if at some future date, the
inclusion of alternative post-acute treatment sites becomes a
requirement rather than an option, the experience of the next round of
projects that include those sites in their systems will serve as a
useful source of information about the transition.
Changes: The background statement and the priority have been
revised to provide projects with the option of including alternative
post-acute treatment sites in their system while maintaining the
requirement that all projects include post-acute inpatient
rehabilitation sites. In addition, the final priority includes an
invitational priority in order to encourage applicants to pursue this
option.
Comment: The phrase ``specific treatment interventions'' should be
added to the fourth purpose of the priority.
Discussion: The fourth purpose of the priority requires a project
to determine the relationship between cost of care and functional
outcomes. In order to make this determination, the project should link
the cost of care to a specific intervention. The commenter's
recommendation clarifies this point.
Changes: The fourth purpose statement has been revised to require a
project to determine the relationship between cost of care, specific
treatment interventions, and functional outcomes.
Comment: The projects should examine the issues of aging with TBI.
Discussion: Applicants have the discretion to propose areas of
investigation as long as those areas are within the purpose of the
priority. However, examining issues of aging with TBI is outside of the
scope of activities that an applicant could propose to fulfill the
purpose of a project in the TBI Model Systems program. There is
insufficient evidence to support establishing an absolute priority on
this topic under other NIDRR research programs.
Changes: None.
Comment: The projects should examine the impact of pre-injury
psychosocial factors on rehabilitation outcomes.
Discussion: Applicants have the discretion to propose areas of
investigation as long as those areas are within the purpose of the
priority. Thus, in response to the revised third purpose statement, an
applicant could propose to delineate the role of premorbid factors in
outcome in TBI. The peer review process will evaluate the merits of the
proposal.
Changes: None.
Comment: The priority refers to a ``multidisciplinary'' model
system of care. The manner in which care is rendered in most, if not
all, the model systems is in an ``interdisciplinary'' or
``transdisciplinary'' fashion. ``Interdisciplinary'' or
``transdisciplinary'' should be used instead of ``multidisciplinary.''
Discussion: The term ``multidisciplinary'' was used to convey that
the projects should involve all necessary and appropriate disciplines
in the delivery of care. Since there are no universally accepted
definitions of any of these terms, use of any one term could lead to a
misunderstanding.
Changes: The term ``multidisciplinary'' has been deleted, and the
priority requires the projects to involve all necessary and appropriate
disciplines in the delivery of care.
Comment: In order to provide the priority with a consumer
perspective, ``subjective well-being'' should be added to the third
purpose statement.
Discussion: The third purpose statement requires the project to
develop key predictors of rehabilitation outcomes at hospital discharge
and at long-term follow-up. Including subjective well-being in the
priority will promote the inclusion of consumers' perspectives among
the rehabilitation outcomes.
Changes: The third purpose statement has been revised to require a
project to address subjective well-being when it develops key
predictors of rehabilitation outcomes.
Comment: The efficacy of interventions should not be weighed
against the cost of interventions alone. Purposes statements four and
five should be revised to refer to ``costs to society.''
Discussion: Determining ``costs to society'' is an imprecise
endeavor. While ``cost of interventions'' admittedly constitutes a more
limited perspective, it is a measure that can be used consistently
across projects with a much higher degree of confidence.
Changes: None.
Comment: The projects should investigate potential systematic
biases in longitudinal studies of persons with TBI.
Discussion: Applicants have the discretion to propose areas of
investigation as long as those areas are within the purpose of the
priority. However, investigating potential systematic biases in
longitudinal studies of persons with TBI is outside of the scope of
activities that an applicant could propose to fulfill the purpose of a
project in the TBI Model Systems program. There is insufficient
evidence to support establishing an absolute priority on this topic
under other NIDRR research programs.
Changes: None.
Comment: The TBI Model Systems program should promote variation in
care, along with systematic data collection, so that the impact of
variations can be studied. To the extent
[[Page 25762]]
that all funded model systems are encouraged to develop similar systems
of care, the opportunity to understand the impact of differences in
care is lost. Specifically, the study of the impact of differences in
the design and organization of rehabilitation interventions can be
advanced by changing the enrollment constraints of model system
patients, including those who are in a vegetative state, encouraging
program innovations, developing innovative financing approaches to TBI
rehabilitation, and supporting rigorous research on the treatment of
both motor and cognitive impairments, including training regimens,
pharmacologic treatments, and the use of orthotic and prosthetic
devices.
Discussion: The TBI Model System program is intended to demonstrate
the effectiveness of a prescribed system of care implemented in a
similar fashion by a number of projects. Some degree of variation
occurs across projects, and this variation will increase markedly if
grantees exercise the option of including alternative post-acute
treatments pathways in their model system of care. The commenter is
correct that to the extent all funded model systems are encouraged to
develop similar systems of care, the opportunity to understand the
impact of differences in care is lost. However, there are substantial
benefits in regard to the quality of the knowledge that can be
generated by demonstrating and evaluating a prescribed system across
projects. In light of the resources available to the program, those
benefits outweigh benefits that would result from a model system that
would systematically promote variation in care.
Changes: None.
Comment: The projects should study the impact of managed care on
healthcare delivery to persons with TBI.
Discussion: Applicants have the discretion to propose areas of
investigation so long as those areas are within the purpose of the
priority. Thus, in response to the revised fourth purpose statement, an
applicant could propose to study the impact of managed care on
healthcare delivery to persons with TBI. The peer review process will
evaluate the merits of the proposal. It should be noted that NIDRR has
recently awarded an RRTC in fiscal year 1997 to study issues in Managed
Health Care for individuals with disabilities.
Changes: None.
Comment: The impact of computers and technology should be
emphasized in the priority.
Discussion: Emerging technology is having a significant impact on
the rehabilitation outcomes of persons with TBI. In order to keep pace
with these developments, all of the TBI Model Systems projects should
identify and evaluate the effectiveness of interventions that use
emerging technology.
Changes: The second purpose of the priority has been revised to
require a project to examine the role of emerging technology in
improving vocational outcomes and community integration.
Comment: Rather than determine the relationships between cost of
care and functional outcomes, the fourth purpose of the priority should
require a project to understand factors that determine costs, i.e.,
``Quantify factors that affect the cost and benefits of care, such as
functional outcomes.''
Discussion: In response to the fourth purpose of the priority, an
applicant could propose to quantify factors that affect the cost and
benefits of care. Determining the relationships between cost of care,
specific treatment interventions, and functional outcomes, and
understanding factors that determine costs are not necessarily
exclusive activities.
Changes: None.
Comment: Control groups or stable baselines are needed to study the
outcomes and value of TBI rehabilitation. Databases that allow
comparisons of similar patients who may experience different treatment
strategies are invaluable in research designed to infer the
effectiveness of rehabilitative interventions. All projects should be
required to participate in controlled research.
Discussion: Applicants have the discretion to propose the research
design that a project will use, and the peer review process will
evaluate the merits of the design. Thus, an applicant could propose to
use controlled research, and the peer review process will evaluate the
merits of the research design. However, requiring all projects to carry
out controlled research could exclude equally effective research
methodologies.
Changes: None.
Comment: The priority does not attend sufficiently to issues
related to acute care of TBI. Attention should be focused on the
prevention of secondary conditions through early rehabilitation
interventions in the acute care setting. Incorporation of this
component permits the investigation of novel pharmacologic strategies
and early cognitive interventions to enhance long-term functional and
vocational outcomes.
Discussion: In response to the revised second purpose statement, an
applicant could propose to emphasize the prevention of secondary
conditions through early rehabilitation interventions in the acute care
setting, and the peer review process will evaluate the merits of the
emphasis. However, there is insufficient evidence to warrant requiring
all applicants to emphasize the prevention of secondary conditions
through early rehabilitation interventions in the acute care setting.
Changes: None.
Comment: Projects should study the effectiveness of behavioral
management strategies and the role of family dynamics in TBI patients.
Discussion: An applicant could propose to study the effectiveness
of behavioral management strategies or the role of family dynamics
under the second and third purpose statements, respectively. The peer
review process will evaluate the merits of the proposals. However,
there is insufficient evidence to warrant requiring all applicants to
study the effectiveness of behavioral management strategies or the role
of family dynamics.
Changes: None.
Rehabilitation Research and Training Centers (RRTCs)
Priority 4: Aging With Spinal Cord Injury
Comment: The background statement acknowledges an array of health
maintenance problems including, but not limited to cardiovascular
problems, urinary tract infections, pressure sores, hypertension,
fractures, blood in the urine or bowel problems, and diabetes. However,
the priority does not include a commensurate purpose statement
requiring the RRTC to address these problems. The employment problems
experienced by persons aging with SCI are usually problems of
maintaining employment, and not gaining employment. Their difficulties
maintaining employment are most often a function of a health
maintenance problem. The priority places too much emphasis on
employment-related issues and fails to address critical health issues.
Discussion: This concern was expressed by thirty-seven of the
thirty-eight comments that the Department received on this proposed
priority by the deadline date. The commenters are persuasive that the
priority places too much emphasis on employment-related issues and
fails to address critical health issues.
Changes: The priority has been revised to include a new purpose
statement addressing health maintenance problems and to de-
[[Page 25763]]
emphasize employment-related issues. In addition, in recognition of the
additional work that will be required to address health maintenance
problems, the number of purpose statements has been reduced and the
dissemination and training requirements have been consolidated and
modified.
Comment: Forty-four percent of the people who get a SCI are members
of a minority group. The RRTC should place special emphasis on people
aging with a SCI from minority backgrounds.
Discussion: The commenter is correct. There are an increasing
number of persons from minority backgrounds who are experiencing SCI,
and their unique and varying needs merit special attention from the
RRTC.
Changes: The background statement and priority have been revised to
evidence the unique needs of persons aging with SCI from minority
backgrounds and require the RRTC to address those needs.
Comment: Proper research designs need to be used to identify the
potential causes of late life changes. Complex cross-sequential designs
are needed to test these questions. Otherwise the results, even from
longitudinal designs (which do not control from the effect of era), are
flawed.
Discussion: An applicant could propose to use complex cross-
sequential designs, and the peer review process will evaluate the
merits of the design. However, requiring all projects to use complex
cross-sequential designs could exclude equally effective research
designs.
Changes: None.
Comment: The part of the second purpose of the priority that
requires the RRTC to evaluate rehabilitation techniques that will
assist individuals aging with SCI to cope with changes should be
revised to develop better assessment and treatment methods for
depression as people attempt to cope.
Discussion: In response to the second purpose statement, an
applicants could propose to develop better assessment and treatment
methods for depression as people attempt to cope, and the peer review
process will evaluate the merits of the proposal. However, there is
insufficient evidence to warrant requiring all applicants to develop
better assessment and treatment methods for depression as people
attempt to cope.
Changes: None.
Comment: The RRTC should address the significant ethnic differences
that exist among caregivers as well as the great diversity in who
serves as caregiver (spouse, parent, sibling, friend, paid attendant).
Discussion: An applicant could propose to address the significant
ethnic differences that exist among caregivers as well as the diversity
in who serves as caregiver under the third purpose of the priority.
There is insufficient evidence to warrant requiring all applicants to
propose to study these two topics.
Changes: None.
Comment: The data from the 1992 SCI Model Systems Annual Report
that is included in the background statement is partially contradicted
by the 1996 SCI Model Systems Annual Report. The background statement
indicates that employment rate peaks at about 40 percent for persons
with paraplegia and at 28 percent for persons with quadriplegia, and
sharply declines about 18 years after the post-injury. However, the
1996 Report shows employment peaking at 39 percent at fifteen years
after injury and at 38.4 percent at 20 years after injury.
Discussion: The 1992 and the 1996 report findings are different,
but not contradictory. However, since the 1996 findings are more
recent, they should be included in the background statement in place of
the 1992 data.
Changes: The background statement uses the information from the
1996 SCI Model Systems Annual Report instead of the 1992 Report data.
Research and Demonstration Projects
Authority for the R&D program of NIDRR is contained in section
204(a) of the Rehabilitation Act of 1973, as amended (29 U.S.C. 760-
762). Under this program the Secretary makes awards to public agencies
and private agencies and organizations, including institutions of
higher education, Indian tribes, and tribal organizations. This program
is designed to assist in the development of solutions to the problems
encountered by individuals with disabilities in their daily activities,
especially problems related to employment (see 34 CFR 351.1). Under the
regulations for this program (see 34 CFR 351.32), the Secretary may
establish research priorities by reserving funds to support the
research activities listed in 34 CFR 351.10.
Priorities
Under 34 CFR 75.105(c)(3), the Secretary gives an absolute
preference to applications that meet one of the following priorities.
The Secretary will fund under this program only applications that meet
one of these absolute priorities:
Priority 1: Burn Injury Rehabilitation Model System
Background
Each year more than 2.0 million persons (about one percent of the
population of the United States) receive a burn injury. Of these, 6,500
to 12,000 do not survive; 500,000 require medical care and result in
temporary disability with respect to home, school, or work activities;
and 70,000 to 100,000 are severe enough to be admitted to a hospital
(Rice, D.P. and MacKenzie, E.J., ``Cost of Injury in the United States:
A Report to Congress,'' Atlanta, GA: Centers for Disease Control,
1989).
In 1994, NIDRR provided funding to establish Burn Injury
Rehabilitation Model Systems of Care. These R&D projects focused
primarily on developing and demonstrating a comprehensive,
multidisciplinary model system of rehabilitative services for
individuals with severe burns, and evaluating the efficacy of that
system through the collection and analysis of uniform data on system
benefits, costs, and outcomes. NIDRR's multi-center model systems
program is designed to study the course of recovery and outcomes
following the delivery of a coordinated system of care including
emergency care, acute care management, comprehensive inpatient
rehabilitation, and long-term interdisciplinary follow-up services.
Burn rehabilitation requires interventions as soon as possible
after admission to hospitals and has treatment implications for several
years following hospital discharge. Burn trauma often causes injuries
and impairments in addition to the burn, and many individuals with burn
injuries have secondary complications related to the burn condition.
These may include open wounds, contractures, neuropathies, cosmetic
abnormalities, deconditioning, bony deformities, hypersensitivity to
heat and cold, amputation, psychosocial distress, chronic pain, and
scarring. The complicated nature of burn injuries, the difficulty of
treatment, and the risk of infection with possible loss of function
requires interventions quickly and frequently to attempt to maintain a
functional lifestyle and return to living independently. Minimization
of physical deterioration and prevention of further impairment and
functional limitation is critical and research is needed to find the
appropriate procedures for clinical applications. Research is needed to
develop and refine methods to determine the effectiveness of
interventions to prevent, manage, and reduce medical
[[Page 25764]]
complications that contribute to short and long-term disability in burn
patients.
Children who are severely burned may present unique challenges to
health care providers, educators, and family members due to the
physical, cognitive and emotional development stages that they
experience. For example, returning to school and neighborhood may pose
a serious threat to the development of a child's self-esteem if
disfigurement is evident. In order to minimize the impact of a severe
burn on a child's development, an efficient, well-coordinated system of
care must be in place that involves medical, rehabilitation, and
educational service providers, including special educators.
Improved measures are needed of an individual's functional ability
as a result of burn rehabilitation interventions. Functional assessment
brings objectivity to rehabilitation by establishing appropriate,
uniform descriptors of rehabilitation care and changes in individual
capacity to perform activities of daily living or other measurable
elements of an individual's major life activities (Granger, C. and
Brownscheidle, C., ``Outcome Measurement in Medical Rehabilitation,''
International Journal of Technology Assessment in Health Care, 11:2,
1995). Increasingly, health and rehabilitation services require
effectiveness and impact measures to evaluate their services as a part
of procedures for cost-reimbursement and billing for services. With
greater emphasis on individual choice in services delivery, consumers
and advocates are likewise advocates for functional assessment measures
as encoders of service effectiveness. Few existing functional
assessment measures, however, address the specialized and complex
combination of psychosocial and medical challenges encountered by an
individual who has experienced severe burn injury (Rucker, K., et al.,
``Analysis of Functional Assessment Instruments for Disability
Rehabilitation Programs,'' SEW Contract No. 600-95-2194, Virginia
Commonwealth University, 1996).
Burn injuries can produce emotional problems, such as post-
traumatic stress disorders, anxiety, and depression. These problems may
result from a variety of causes (e.g., reaction to cosmetic
alterations, changes in functional abilities, changes in work status,
restrictions on recreational activities) (Cromes, G.F. and Helm, P.A.,
``Burn Injuries,'' in Medical Aspects of Disability, pgs. 92-104,
1993). The aesthetic disability of disfigurement is frequently more
severe than the physical disability and may result in profound social
consequences for those afflicted (Hurren, J.S., ``Rehabilitation of the
Burned Patient: James Laing Memorial Essay for 1993,'' Burns, Vol. 21,
No. 2, 1995). The more severe the burn, the greater the likelihood of
long-term psychosocial adjustment issues related to both physical and
psychosocial problems, that affect quality of life. Although
psychosocial adjustment is a critical factor in the long-term recovery
of burn injury patients, there continues to be limited emphasis on
research in the area of psychosocial rehabilitation and its
relationship to quality of life. Family and friends play an important
role and provide major support in the psychological recovery of burn
patients. Research in this area needs to address the role of the family
and personal advocacy systems in providing support during the burn
injury rehabilitation process.
Difficulty with long-term follow-up of all patients after hospital
discharge has always been a problem, but it is even more difficult when
the individual lives far from the specialized rehabilitation unit.
Problems are also encountered with those individuals living in rural
areas, where access to burn injury rehabilitation, including mental
health services, may be quite limited due to lack of proximity to
specialized practitioners, limited access to technological advances,
and hospital closures.
Return-to-work and educational pursuits are important measures of
rehabilitation success. Work is an important source of satisfaction,
self-respect, and dignity, as well as an arena for socialization for
individuals who have experienced burn injury (Salisbury, R., ``Burn
Rehabilitation: Our Unanswered Challenge,'' 1992 Presidential Address
to the American Burn Association, April, 1992). However, the efficacy
of vocational rehabilitation interventions for this population has not
been documented adequately. The physical, psychosocial, and emotional
factors that lead to successful employment have not been clearly
identified. Research is needed to examine relationships between
vocational interventions and supports, employment, functional capacity,
and degree of burn injury, including secondary complications.
Priority 1
The Secretary will establish Burn Injury Rehabilitation Model
Systems R&D projects for the purpose of demonstrating a comprehensive,
model system of rehabilitative services, involving all necessary and
appropriate disciplines, for children and adults with severe burns from
point of injury to community integration and long-term follow-up. An
R&D project must:
(1) Identify and evaluate techniques to prevent secondary
complications;
(2) Develop and evaluate outreach programs to improve follow-up
services for rural populations;
(3) Develop and evaluate measures of functional outcome for burn
rehabilitation; and
(4) Identify and evaluate interventions, including vocational
rehabilitation and special education interventions, to improve
psychosocial adjustment, quality of life, community integration, and
education and employment-related outcomes.
In carrying out these purposes, the R&D project must:
Participate in clinical and systems analysis studies of
the burn injury rehabilitation model system by collecting and
contributing data on patient characteristics, diagnoses, causes of
injury, interventions, outcomes, and costs to a uniform, standardized
national data base as prescribed by the Secretary; and
Consider collaborative projects with other model systems.
Priority 2: Traumatic Brain Injury Model Systems
Background
An estimated 1.9 million Americans experience traumatic brain
injury (TBI) each year (Collins, J.F., ``Types of Injuries by Selected
Characteristics: US 1985-87,'' National Center for Health Statistics,
Vital Health Stat 10 (175), 1990). Incidence is highest among youth and
younger adults. Young males have the highest incidence rates of any
group (``Disability Statistics Abstract,'' No. 14, Disability
Statistics Rehabilitation Research & Training Center, University of
California, San Francisco, November, 1995). Each year approximately
70,000 to 90,000 TBI survivors enter a life of continuing, debilitating
loss of function; an estimated 5,000 survivors experience seizure
disorders; and 2,000 enter into a persistent vegetative state. The
number of people surviving head injuries has increased significantly
over the last 25 years as a result of faster and better emergency
treatment, more rapid and safer transport to specialized treatment
facilities, and advances in medical treatment (National Foundation for
Brain Research, Washington, DC, 1994).
In 1987, NIDRR provided funding to establish TBI Model Systems of
Care. These R&D projects focused primarily
[[Page 25765]]
on developing and demonstrating a comprehensive, multidisciplinary
model system of rehabilitative services for individuals with TBI, and
evaluating the efficacy of that system through the collection and
analysis of uniform data on system benefits, costs, and outcomes.
NIDRR's multi-center model systems program is designed to study the
course of recovery and outcomes following the delivery of a coordinated
system of care including emergency care, acute neuro-trauma management,
comprehensive inpatient rehabilitation, and long-term interdisciplinary
follow-up services. Projects are being given an option at this time of
including, in addition to comprehensive inpatient rehabilitation,
alternative pathways of post-acute treatment such as skilled nursing
facilities, subacute rehabilitation facilities, and home care.
The TBI Model Systems serve a substantial number of patients,
allowing the projects to conduct clinical research and program
evaluation, which maximize the potential for project replication. In
addition, the TBI Model Systems have the advantage of a complex data
collection and retrieval program with the capability to analyze the
different system components and provide information on project cost
effectiveness and benefits. Information is collected throughout the
rehabilitation process, permitting long-term follow-up on the course of
injury, outcomes, and changes in employment status, community
integration, substance abuse and family needs. The TBI Model Systems
projects serve as regional and national models for program development
and as information centers for consumers, families, and professionals.
The TBI Model Systems National Database reports that the average
length of stay in acute care has decreased approximately 50 percent,
from 30 days in 1989 to 15 days in 1996; and the average length of stay
in inpatient rehabilitation has decreased 38 percent, from 52 days in
1989 to 32 days in 1996. With the changing patterns of service
delivery, there continues to be a need to establish and evaluate new
rehabilitation interventions and strategies. Specialized measurement
tools have been developed by the TBI Model Systems to assess progress
and describe clinical and functional outcomes. Refinement of these
measurement tools is necessary to demonstrate the effectiveness of
rehabilitation interventions in inpatient and outpatient settings.
After the individual is discharged from an inpatient setting, there is
an ongoing need for outpatient and community reintegration services in
order to continue therapeutic interventions and the educational and
referral process. As the average length of stay in inpatient settings
decreases, there is a greater need to evaluate outpatient and community
reintegration programs.
Findings from a multi-center investigation of employment and
community integration following TBI highlight the need for post-acute
rehabilitation programs with particular emphasis on vocational
rehabilitation (Sander, A., et al., Journal of Head Trauma
Rehabilitation, Vol. 11, No. 5, pgs. 70-84, 1996). Kreutzer states that
employment and productivity, relating to others in the community, and
independently caring for oneself at home are important quality-of-life
components (``TBI: Models and Systems of Care,'' Conference Syllabus,
Medical College of Virginia, April, 1996). As functional recovery
progresses during the first year or more after the injury, the focus of
rehabilitation shifts from medical intervention and physical
restoration to psychosocial and vocational adaptation. The ultimate
goal of psychosocial and vocational rehabilitation is community
reintegration and employment. It is important to emphasize that
services aimed at community reintegration must consider not only
attributes and limitations of the injured individuals, but also the
social, educational, and vocational systems in which the individual
will function. In addition, rates of competitive employment decrease
substantially from pre-injury levels. Head injury frequently results in
unemployment, and there are significant relationships between risk
factors (e.g., substance abuse) and this changed employment status.
However, there is no reliable information regarding the magnitude of
risk associated with different factors, or with different levels of
these factors (Dikmen, S., et al., ``Employment following Traumatic
Head Injuries,'' Archives of Neurology, Vol. 51, February, 1994).
A major disability like TBI has a profoundly disorganizing impact
on the lives of individuals with TBI and their families. Questions
involving community, family, and vocational restoration, as well as
generic concerns about future happiness and fulfillment, are common
(Banja, J., & Johnston, M., ``Ethical Perspectives and Social Policy,''
Archives of Physical Medicine Rehabilitation, Vol. 75, SC-19, December,
1994). Even individuals who have integrated well into society
experience adverse psychosocial effects. Employment instability,
isolation from friends, and increased need for support are a few of the
problems encountered by individuals with TBI. Families often function
as the primary support system for individuals with TBI after they are
discharged. There is a clear need for research to develop family
treatment strategies and explore their effect on outcomes for
individuals with TBI.
The health care costs associated with TBI are staggering. The
direct medical costs of TBI treatment have been estimated at more than
$4 billion annually (Max, W., et al., ``Head Injuries: Costs and
Consequences,'' Journal of Head Trauma Rehabilitation, Vol. 6, pgs. 76-
91, 1991). In view of current scrutiny of all health care spending,
which may result in pressures to constrict or deny rehabilitation care
to individuals with traumatic brain injury, it is important to gather
information on the efficacy and cost-effectiveness of various treatment
interventions and service delivery models. Credible outcome monitoring
systems are needed to establish guidelines by which fair compromises
can be reached (Johnston, M. & Hall, K., ``Outcomes Evaluation in TBI
Rehabilitation, Part I: Overview and System Principles,'' Archives of
Physical Medicine and Rehabilitation, Vol. 75, December, 1994). A
greater emphasis on outcomes measurements and management will foster
the gathering of information on efficacy and cost-effectiveness.
Violence-induced TBI is increasingly common, and has significant
implications for rehabilitation and community reintegration. According
to the 1991 National Health Interview Survey data, violence was
responsible for nine percent of all non-fatal TBIs. In addition,
violence was a cause of injury in 30 percent of the 684 external injury
cases in the TBI Model Systems database (a higher frequency due, in
part, to the urban setting of one of the TBI Model Systems). The
frequency of violence as a cause of TBI, in part, can be attributed to
the fact that the individuals most likely to sustain TBI (i.e., males
under age 18) are also those most likely to be involved in crimes and
violence. The increase in violence as a cause of brain injury may have
consequences with regard to rehabilitation costs, treatment
interventions and long-term outcomes. For example, individuals with
violence-related injuries show more difficulties with community
integration skills one year following injury, which evidences itself in
areas of social integration and productivity. Further research is
needed to examine whether individuals who sustain a TBI as a result of
violence
[[Page 25766]]
require specialized rehabilitation interventions.
Priority 2
The Secretary will establish Model Systems TBI R&D projects for the
purpose of demonstrating a comprehensive, model system of care for
individuals with TBI, involving all necessary and appropriate
disciplines. An R&D project must:
(1) Investigate the efficacy of alternative methods of service
delivery interventions after inpatient rehabilitation discharge and
after other post-acute treatment pathways when applicable;
(2) Identify and evaluate interventions, including those utilizing
emerging technology, that can improve vocational outcomes and community
integration;
(3) Develop key predictors of rehabilitation outcome, including
subjective well-being, at hospital discharge and at long-term follow-
up;
(4) Determine the relationship between cost of care, specific
treatment interventions, and functional outcomes; and
(5) Examine the implications of violence as a cause of TBI on
treatment interventions, rehabilitation costs, and long-term outcomes.
In carrying out these purposes, the R&D Systems project must:
Participate in clinical and systems analysis studies of
the traumatic brain injury model system by collecting and contributing
data on patient characteristics, diagnoses, causes of injury,
interventions, outcomes, and costs to a uniform, standardized national
data base as prescribed by the Secretary;
Consider collaborative projects with other model systems;
and
Coordinate research efforts with other NIDRR grantees that
address TBI-related issues.
Invitational Priority: The Secretary is particularly interested in
applications that address the following invitational priority within
this absolute priority. However, under 34 CFR 75.105(c)(1) an
application that meets an invitational priority does not receive
competitive or absolute preference over other applications. The
invitational priority is for projects that include, in addition to
comprehensive inpatient rehabilitation, alternative pathways of post-
acute treatment such as skilled nursing facilities, subacute
rehabilitation facilities, and home care.
Rehabilitation Research and Training Centers (RRTCs)
Authority for the RRTC program of NIDRR is contained in section
204(b)(2) of the Rehabilitation Act of 1973, as amended (29 U.S.C. 760-
762). Under this program the Secretary makes awards to public and
private organizations, including institutions of higher education and
Indian tribes or tribal organizations for coordinated research and
training activities. These entities must be of sufficient size, scope,
and quality to effectively carry out the activities of the Center in an
efficient manner consistent with appropriate State and Federal laws.
They must demonstrate the ability to carry out the training activities
either directly or through another entity that can provide such
training.
The Secretary may make awards for up to 60 months through grants or
cooperative agreements. The purpose of the awards is for planning and
conducting research, training, demonstrations, and related activities
leading to the development of methods, procedures, and devices that
will benefit individuals with disabilities, especially those with the
most severe disabilities.
Under the regulations for this program (see 34 CFR 352.32) the
Secretary may establish research priorities by reserving funds to
support particular research activities.
Description of the Rehabilitation Research and Training Center
Program
RRTCs are operated in collaboration with institutions of higher
education or providers of rehabilitation services or other appropriate
services. RRTCs serve as centers of national excellence and national or
regional resources for providers and individuals with disabilities and
the parents, family members, guardians, advocates or authorized
representatives of the individuals.
RRTCs conduct coordinated and advanced programs of research in
rehabilitation targeted toward the production of new knowledge to
improve rehabilitation methodology and service delivery systems, to
alleviate or stabilize disabling conditions, and to promote maximum
social and economic independence of individuals with disabilities.
RRTCs provide training, including graduate, pre-service, and in-
service training, to assist individuals to more effectively provide
rehabilitation services. They also provide training including graduate,
pre-service, and in-service training, for rehabilitation research
personnel and other rehabilitation personnel.
RRTCs serve as informational and technical assistance resources to
providers, individuals with disabilities, and the parents, family
members, guardians, advocates, or authorized representatives of these
individuals through conferences, workshops, public education programs,
in-service training programs and similar activities.
NIDRR encourages all Centers to involve individuals with
disabilities and minorities as recipients in research training, as well
as clinical training.
Applicants have considerable latitude in proposing the specific
research and related projects they will undertake to achieve the
designated outcomes; however, the regulatory selection criteria for the
program (34 CFR 352.31) state that the Secretary reviews the extent to
which applicants justify their choice of research projects in terms of
the relevance to the priority and to the needs of individuals with
disabilities. The Secretary also reviews the extent to which applicants
present a scientific methodology that includes reasonable hypotheses,
methods of data collection and analysis, and a means to evaluate the
extent to which project objectives have been achieved.
The Department is particularly interested in ensuring that the
expenditure of public funds is justified by the execution of intended
activities and the advancement of knowledge and, thus, has built this
accountability into the selection criteria. Not later than three years
after the establishment of any RRTC, NIDRR will conduct one or more
reviews of the activities and achievements of the Center. In accordance
with the provisions of 34 CFR 75.253(a), continued funding depends at
all times on satisfactory performance and accomplishment.
General
The following requirements apply to these RRTCs pursuant to the
priorities unless noted otherwise:
Each RRTC must conduct an integrated program of research to develop
solutions to problems confronted by individuals with disabilities.
Each RRTC must conduct a coordinated and advanced program of
training in rehabilitation research, including training in research
methodology and applied research experience, that will contribute to
the number of qualified researchers working in the area of
rehabilitation research.
Each RRTC must disseminate and encourage the use of new
rehabilitation knowledge. They must publish all
[[Page 25767]]
materials for dissemination or training in alternate formats to make
them accessible to individuals with a range of disabling conditions.
Each RRTC must involve individuals with disabilities and, if
appropriate, their family members, as well as rehabilitation service
providers, in planning and implementing the research and training
programs, in interpreting and disseminating the research findings, and
in evaluating the Center.
Priorities
Under 34 CFR 75.105(c)(3), the Secretary gives an absolute
preference to applications that meet one of the following priorities.
The Secretary will fund under these competitions only applications that
meet one of these absolute priorities:
Priority 3: Effective Interventions for Children and Youth With
Disabilities Who Exhibit Severe Problem Behaviors
Background
In recent years researchers have focused on the application of non-
aversive approaches to reduce and eliminate severe problem behaviors
(SPBs) exhibited by children and youth with disabilities. This has been
the case because of ethical concerns about aversive interventions
expressed by disability professionals, parents, and advocates, as well
as research findings which indicate that aversive interventions are
largely ineffective in eliminating or reducing SPBs over an extended
period of time. Because of their disruptive nature, SPBs such as
physical aggression, self-injury, violence, and property destruction
are among the primary obstacles to full inclusion of children and youth
with disabilities in age-appropriate community-based activities and
regular education settings. School and community-based program
personnel need effective methods to reduce and eliminate SPBs in order
to provide these children and youth with disabilities with
opportunities to learn, play, and work with their non-disabled peers.
Previous research in this area has improved our understanding of
the early indicators of SPBs. For example, children with disabilities
who display minor self-injurious behavior during the preschool years
are strong candidates to exhibit more SPBs within two years (Hall, S.,
``Early Intervention of Self-injurious Behavior in Young Children with
Intellectual Disabilities: Naturalistic Observation,'' Presented at the
Annual Meeting of the American Association of Mental Retardation, San
Francisco, June, 1995). Further research is needed on how severe
problem behavior patterns develop and whether early intervention
efforts can reduce, and perhaps prevent, SPBs.
Preliminary research has also indicated that problem behaviors can
be reduced by understanding the antecedents to and function of the
behavior. Accordingly, children and youth with disabilities who exhibit
SPBs may be able to learn to self-manage their problem behaviors.
While there are encouraging indications that non-aversive
approaches can be effective in reducing and eliminating SPBs, there is
a need to develop effective interventions that can be maintained over
extended periods of time. Treatments of self-injurious behaviors are
particularly problematic in regard to long-term effectiveness. Research
has shown that children who exhibit self-injurious behaviors, even
after intensive non-aversive treatment programs, may revert to self-
injury at high rates within a few months of intervention (Durand, V.M.,
et al., ``The Course of Self-injurious Behavior Among People with
Autism,'' Paper presented at the Annual Meeting of the Berkshire
Association for Behavior Analysis and Therapy, Amherst, MA. 1995).
Information from functional assessments can be used to develop
educational plans and address inappropriate behavior. Functional
assessment is the general label assigned to describe a set of processes
(e.g., interviews, rating, rating scales, direct observations, and
systematic experimental analyses of specific situations) for defining
the events in an environment that reliably predict and maintain
behaviors. More research needs to be done in order to expand the
application of functional assessments with children and youth with
disabilities who exhibit severe problem behaviors.
Under normal circumstances, children and youth with disabilities
who exhibit SPBs in school and the community are also exhibiting these
behaviors at home. In order for non-aversive approaches to be
implemented consistently across environments, parents and other
caregivers must not only consent to the approach, but also be capable
of implementing the approach effectively in the home environment. The
non-aversive strategies that are developed must be compatible with the
home environment, and take into account providing parents and guardians
with the skills they need to implement the program effectively.
Priority 3
The Secretary will establish an RRTC for the purpose of providing
school and community-based program personnel with effective methods to
reduce and eliminate SPBs in children and youth with disabilities. The
RRTC shall:
(1) Develop and evaluate non-aversive interventions that reduce and
eliminate severe behavior problems exhibited by children and youth with
disabilities;
(2) Investigate the etiology of SPBs for the purpose of developing
prevention and early intervention strategies;
(3) Investigate the durability and maintenance of effective non-
aversive interventions;
(4) Investigate the effectiveness of self-management strategies;
(5) Develop and evaluate functional assessments to address SPBs in
educational and community-based settings;
(6) Develop materials and provide training to educators, community-
based program personnel, parents, and caregivers who address SPBs; and
(7) Develop and disseminate informational materials and provide
technical assistance to local and State educational agencies to address
SPBs.
In carrying out the purposes of the priority, the RRTC shall
disseminate materials and coordinate training activities with related
projects supported by the Office of Special Education Programs,
including the Regional Resource Centers and Parent Information Centers.
Priority 4: Aging With Spinal Cord Injury
Background
While the mortality rate of persons who experience a spinal cord
injury (SCI) and related conditions has improved markedly, life
expectancy estimates are still well below normal (DeVivo, M. and
Stover, S., ``Long-term Survival and Causes of Death,'' in Spinal Cord
Injury: Clinical Outcomes from the Model Systems, Aspen Publications,
Gaithersburg, Maryland, 1995). Estimates of spinal cord injury
prevalence in America range from 180,000 to 250,000 with between 7,000
and 10,000 new spinal cord injuries each year (National Spinal Cord
Injury Statistical Center, The University of Alabama at Birmingham,
1995). One of four individuals who previously sustained a spinal cord
injury is now at least 20 years post-onset. The average age of a SCI
survivor is now about 48 years and about 20 percent of SCI survivors
are over age 60.
Many SCI survivors develop new medical, functional, and
psychological
[[Page 25768]]
problems that threaten their independence. In addition, many experience
job loss, barriers to accessing proper health maintenance and
caregiver/personal assistance services, loss of financial assistance,
and economic hardship. Persons aging with SCI are susceptible to
multiple health maintenance problems including, but not limited to,
cardiovascular problems, urinary tract infections, pressure sores,
hypertension, fractures, blood in the urine or bowel problems, and
diabetes (Whiteneck, G.(Ed.), Aging with a Spinal Cord Injury, 1992).
The leading medical cause of death and further disability that affects
people with SCI is now premature cardiovascular disease of the
atherosclerotic kind. Whiteneck, using data from England, found that
cardiovascular disease is now tied with genito-urinary problems as the
leading cause of death in people aging with SCI.
Individuals aging with a SCI also experience complications as a
result of osteoporosis and lower extremity fractures (Garland, D.E.,
``Bone Mineral Density about the Knee in SCI Patients with Pathological
Fractures,'' Contemporary Orthopaedics, 1992 and Garland, D.E.,
``Osteoporosis Following SCI,'' Journal of Orthopaedic Research, 1992).
Garland discovered a high prevalence of carpal tunnel syndrome, which
increased with the length of time after injury. In addition, Sie found
an increased prevalence of general upper extremity pain and shoulder
pain with time since injury in both paraplegic and tetraplegia
individuals (Sie, I., ``Upper Extremity Pain in the Post-Rehabilitation
SCI Injured Patient,'' Archives of Physical Medicine and
Rehabilitation, 1992). Shoulder pain occurs in about 50 percent of
people with paraplegia secondary to prolonged wheelchair use. Pain,
fatigue and weakness are also commonly reported but accommodations for
them are poorly understood.
The 1996 SCI Model Systems Annual report shows employment peaking
at 39 percent at fifteen years after injury and at 38.4 percent at 20
years after injury. Interventions are needed to maintain the employment
status of people aging with SCI and prevent job loss due to premature
aging effects. In addition, further research is needed to determine the
changes in functional ability to perform activities of daily living
(ADL) and work.
As people age and their functioning changes, the need for
assistance from others (i.e., family, friends, and paid caregivers)
increases. Strategies to best assist the caregiver, in turn, to help
the person who is aging with SCI need to be developed. Moreover, there
is no ``typical'' caregiver; some are spouses, some are parents, and
some are children. Fifty percent of people with SCI receive help
exclusively from their families, and an additional 19 percent receive
substantial help from their families. Living with family is the most
frequently reported living situation, occurring in over 90 percent of
cases (Nosek, M.A., ``Personal Assistance: Key to Maintaining Ability
of Persons with Physical Disabilities,'' Applied Rehabilitation
Counselor, Vol. 21, 1990).
Declining or unstable support systems for people aging with SCI are
also a major concern. Since parents of aging SCI individuals are often
elderly, they are also at risk of poor health or death. Spousal support
providers may experience ``burn-out'' and stress, or develop health
problems. There are few alternatives to the informal support system. As
individuals with SCI age, access to proper health care, especially with
the growing trend toward managed care, is becoming a bigger problem.
There is need for research on maintaining independence in the community
for people aging with SCI through both the informal and formal systems
of care.
Psychological well-being for individuals aging with SCI is also of
major concern. Depression is a very important issue requiring
additional study because of its bearing on quality of life, its
importance for overall health, and its relationship to suicide (Schulz,
R., ``Long Term Adjustment to Physical Disability: The Role of Social
Support Service of Control and Self Blame,'' Journal of Personality and
Social Psychology, 5, pgs. 1162-1172, 1985). The research indicates
that over 40 percent of people who have sustained functional changes as
a consequence of aging with SCI show high levels of distress and
depression. Pilot data on treatment are available from the NIDRR-funded
centers, but a full treatment procedure for stress and depression needs
to be developed.
A significant trend over time has been observed in the racial
distribution of persons in the SCI Model Systems database. Among
persons injured between 1973 and 1978, 77.5 percent of persons in the
database were Caucasian, 13.6 percent were African-American, and 6
percent were Hispanic. Among those injured since 1990, 55.2 percent
were Caucasian, 29 percent were African-American, and 12.8 percent were
Hispanic (``Spinal Cord Injury, Facts and Figures at a Glance,''
National Spinal Cord Injury Statistical Center, University of Alabama
at Birmingham, July, 1996). This increase in incidence of SCI among
persons from minority backgrounds is accompanied by research at the
current RRTC on Aging with SCI indicating that people from minority
backgrounds experience different long-term consequences from SCI.
Priority 4
The Secretary will establish an RRTC for the purpose of conducting
research on rehabilitation techniques that assist individuals aging
with SCI to maintain employment and independence in the community. The
RRTC shall:
(1) Identify, develop, and evaluate interventions to address health
maintenance issues, and prevent and treat secondary conditions for
individuals aging with SCI;
(2) Identify, develop, and evaluate rehabilitation techniques that
will assist individuals aging with SCI to maintain employment and to
cope with changes in functional abilities and ADL;
(3) Investigate how formal and informal systems of care could be
improved to address the impact of problems associated with long-term
care givers and personal service assistants;
(4) Develop a better understanding of the natural course of SCI as
persons age and develop regimens to minimize or take account of the
impacts of aging with SCI; and
(5) Develop materials and a program of information dissemination
and training for individuals aging with SCI, their families, service
providers and educators that will assist them to understand the natural
course of SCI as persons age.
In carrying out the purposes of the priority, the RRTC shall:
Emphasize the needs of persons from minority backgrounds;
and
Coordinate with all other relevant SCI research and
demonstration activities, including those sponsored by the National
Center on Medical Rehabilitation Research, the Rehabilitation Services
Administration, Paralyzed Veterans of America, National Spinal Cord
Injury Association and NIDRR-funded SCI projects.
Knowledge Dissemination and Utilization Projects
Authority for the D&U program of NIDRR is contained in sections 202
and 204(a) of the Rehabilitation Act of 1973, as amended (29 U.S.C.
760-762). Under this program the Secretary makes awards to public and
private organizations, including institutions of higher education and
Indian tribes or tribal organizations. Under the regulations for this
program (see 34 CFR 355.32), the Secretary may establish
[[Page 25769]]
research priorities by reserving funds to support particular research
activities.
Priority
Under 34 CFR 75.105(c)(3), the Secretary gives an absolute
preference to applications that meet the following priority. The
Secretary will fund under this competition only applications that meet
this absolute priority:
Priority 5: Improving the Utilization of Existing and Emerging
Rehabilitation Technology in the State Vocational Rehabilitation
Program
Background
One of the more persistent issues in the rehabilitation of
individuals with disabilities has been maximizing the use of existing
and emerging rehabilitation technology in the service settings of the
State Vocational Rehabilitation (VR) programs. As defined in Section
7(13) of the Rehabilitation Act, as amended (Act), rehabilitation
technology means ``the systematic application of technologies,
engineering methodologies, or scientific principles to meet the needs
of and address the barriers confronted by individuals with disabilities
in areas which include education, rehabilitation, employment,
transportation, independent living and recreation'' and includes
``rehabilitation engineering, assistive technology devices, and
assistive technology services.'' Under Section 101(a)(5)(C) of the Act,
designated VR agencies must describe in their State plan how the State
will provide a broad range of rehabilitation technology services at
each stage of the rehabilitation process. As appropriate,
rehabilitation technology services are provided to individuals with
disabilities served by State VR programs under an Individualized
Written Rehabilitation Program.
Rehabilitation technology, and information about rehabilitation
technology, is generated by a variety of sources including, but not
limited to, NIDRR-funded Rehabilitation Engineering and Research
Centers, the Assistive Technology program funded under the Technology-
Related Assistance for Individuals with Disabilities Act of 1988,
ABLEDATA, the Department of Veteran's Affairs Research and Development
projects, and manufacturers in the private sector. While many of these
sources may undertake dissemination activities, too often
rehabilitation counselors and related vocational rehabilitation service
providers are unaware of existing or emerging rehabilitation
technologies, resulting in a number of problems for clients of the
State vocational rehabilitation system.
The provision of inappropriate rehabilitation technology can result
in nonuse. The nonuse of a device may lead to decreases in functional
abilities, freedom, and independence. On a service delivery level,
device abandonment represents ineffective use of limited funds by
Federal, State, and local government agencies, insurers, and other
provider organizations (Phillips, B. and Hongxin, Z., ``Predictors of
Assistive Technology Abandonment,'' Assistive Technology, Vol. 5, No.
1, pg. 36, 1993).
If vocational rehabilitation personnel are unfamiliar with an
emerging technology, their clients are disadvantaged by not having
access to recent developments in the field. These developments may be
more effective and economical than existing rehabilitation technology.
Because of the costs that can be involved, the decision to utilize a
particular rehabilitation technology, even if the technology is
outdated, can be difficult to reverse or modify.
Information barriers related to rehabilitation technology also
apply to secondary students with disabilities who increasingly complete
their education with the help of assistive devices (Everson, J.,
``Using Person-centered Planning Concepts to Enhance School-to-Adult
Life Transition Planning,'' Journal of Vocational Rehabilitation, Vol.
6, 1996). In order to ensure their continued access to technical
accommodation as part of their transition to employment and independent
living, special education and vocational rehabilitation personnel
involved in their transition must have proper training and access to
current information.
Assigning inappropriate or outdated rehabilitation technology to
consumers can be avoided if vocational rehabilitation personnel are
provided with comprehensive and current information on existing and
emerging rehabilitation technology. Rehabilitation counselors and
related vocational rehabilitation service providers gain access to
information about rehabilitation technology from various sources
including, but not limited to, their pre-service and in-service
training, memberships in professional organizations, conferences, and
more recently through the information superhighway. Because the field
of rehabilitation technology is developing rapidly, and because it is a
technically diverse and complex field, it has been a challenge for
rehabilitation personnel development programs to keep pace with
rehabilitation technology. There is a growing need for dissemination of
information about rehabilitation technology, including the development
of pre-service and in-service resources, in order to promote improved
rehabilitation professional training on rehabilitation technology.
Priority 5
The Secretary will establish a knowledge dissemination and
utilization project for the purpose of improving the ability of
rehabilitation professionals to more effectively use rehabilitation
technology in providing services to individuals through the State VR
Services program. The D&U project must:
(1) Evaluate the pre-service and in-service rehabilitation
professional training materials that address rehabilitation technology
and identify strengths and deficiencies in those materials;
(2) Based on this evaluation, develop training materials that will
improve the ability of rehabilitation counselors and related
professionals to utilize existing and emerging rehabilitation
technology;
(3) Disseminate these materials to pre-service and in-service
rehabilitation professional training programs;
(4) As needed, provide technical assistance to these pre-service
and in-service training programs to maximize the use of the materials;
and
(5) Using a variety of strategies, disseminate information about
existing and emerging rehabilitation technology to rehabilitation
counselors, special educators involved with the transition of secondary
students, and related rehabilitation professionals.
In carrying out the purposes of the priority, the D&U project must:
Coordinate with the Assistive Technology projects to avoid
duplication of effort;
Develop information about existing and emerging
rehabilitation technology from a wide variety of sources; and
On a regular basis, update the information and materials
that are developed.
APPLICABLE PROGRAM REGULATIONS: 34 CFR Parts 350, 351, and 352. Program
Authority: 29 U.S.C. 760-762.
(Catalog of Federal Domestic Assistance Numbers: 84.133A, Research
and Demonstration Projects, 84.133B, Rehabilitation Research and
Training Center Program, 84.133D, Knowledge Dissemination and
Utilization Program)
[[Page 25770]]
Dated: May 6, 1997.
Judith E. Heumann,
Assistant Secretary for Special Education and Rehabilitative Services.
[FR Doc. 97-12259 Filed 5-8-97; 8:45 am]
BILLING CODE 4000-01-P
