[Federal Register Volume 63, Number 113 (Friday, June 12, 1998)]
[Notices]
[Pages 32526-32539]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-15697]
[[Page 32525]]
_______________________________________________________________________
Part IV
Department of Education
_______________________________________________________________________
National Institute on Disability and Rehabilitation Research; Notice of
Final Funding Priorities for Fiscal Years 1998-1999 for Certain Centers
and Office of Special Education and Rehabilitative Services; Notice
Inviting Applications for New Rehabilitation Research and Training
Centers and New Rehabilitation Engineering Research Centers for Fiscal
Year 1998
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 /
Notices
[[Page 32526]]
DEPARTMENT OF EDUCATION
National Institute on Disability and Rehabilitation Research;
Notice of Final Funding Priorities for Fiscal Years 1998-1999 for
Certain Centers
SUMMARY: The Secretary announces funding priorities for three
Rehabilitation Research and Training Centers (RRTCs) and four
Rehabilitation Engineering Research Centers (RERCs) under the National
Institute on Disability and Rehabilitation Research (NIDRR) for fiscal
years 1998-1999. The Secretary takes this action to focus research
attention on areas of national need. These priorities are intended to
improve rehabilitation services and outcomes for individuals with
disabilities.
EFFECTIVE DATE: This priority takes effect on July 13, 1998.
FOR FURTHER INFORMATION CONTACT: Donna Nangle. Telephone: (202) 205-
5880. Individuals who use a telecommunications device for the deaf
(TDD) may call the TDD number at (202) 205-5516. Internet:
Donna__Nangle@ed.gov
Individuals with disabilities may obtain this document in an
alternate format (e.g., Braille, large print, audiotape, or computer
diskette) on request to the contact person listed in the preceding
paragraph.
SUPPLEMENTARY INFORMATION: This notice contains final priorities under
the Disability and Rehabilitation Research Projects and Centers Program
for three RRTCs related to: aging with a disability, arthritis
rehabilitation, and stroke rehabilitation. The notice also contains
final priorities for four RERCs related to: prosthetics and orthotics,
wheeled mobility, technology transfer, and telerehabilitation.
These final priorities support the National Education Goal that
calls for every adult American to possess the skills necessary to
compete in a global economy.
The authority for the Secretary to establish research priorities by
reserving funds to support particular research activities is contained
in sections 202(g) and 204 of the Rehabilitation Act of 1973, as
amended (29 U.S.C. 761a(g) and 762).
Note: This notice of final priorities does not solicit
applications. A notice inviting applications is published in this
issue of the Federal Register.
Analysis of Comments and Changes
On March 3, 1998, the Secretary published a notice of proposed
priorities in the Federal Register (62 FR 10428-10437). The Department
of Education received forty-five letters commenting on the notice of
proposed priority by the deadline date. Technical and other minor
changes--and suggested changes the Secretary is not legally authorized
to make under statutory authority--are not addressed.
Rehabilitation Research and Training Centers--General
Comment: One commenter suggested that NIDRR should do more than
encourage all Centers to involve individuals with disabilities as
recipients of research training and clinical training. A second
commenter suggested that RRTCs should be required to hire individuals
with disabilities.
Discussion: Involvement of individuals with disabilities is one of
the general requirements that apply to all RRTCs. All RRTCs must
``involve individuals with disabilities and, if appropriate, their
representatives, in planning and implementing its research, training,
and dissemination activities, and in evaluating the Center.''
Applications for RRTCs are evaluated, in part, on the extent to which
the applicant encourages individuals with disabilities to apply for
employment.
Changes: None.
Comment: NIDRR received a comment in response to the proposed
priority on Arthritis Rehabilitation that suggested that NIDRR require
the RRTC to collaborate with arthritis-related organizations as well as
other RRTCs.
Discussion: This comment prompted a general review of all of the
collaboration and coordination requirements contained in the proposed
RRTC and RERC priorities to determine their appropriateness and
consistency. That review revealed some inconsistency in language
requiring clarification.
Changes: The RRTC priorities have been revised to clarify that
having met the stated collaboration or coordination requirements, each
RRTC has the authority to collaborate or coordinate with other entities
carrying out related activities.
Comment: NIDRR received comments in a preceding FY 98 RERC
competition that suggested that the requirements for conducting a
state-of-the-science conference and publishing a final report should be
more flexible.
Discussion: As a result of this comment, NIDRR revised the general
state-of-the-science conference and final report requirement in the
preceding priority. The following reason was provided for this change:
``Information from the state-of-the-science conference will be used, in
conjunction with NIDRR's programs reviews and other inputs in the
determination of future research issues and as part of NIDRR's
Government Performance Results Act database. The budget planning
process requires this information to be available during the fourth
year of a five year grant. As long as the report is available in the
fourth year of the grant, grantees should have as much flexibility as
possible in regard to the scheduling of the state-of-the-science
conference.''
Changes: To be consistent with the state-of-the-science conference
requirement used in the previous priority, it has been revised in the
RRTC and RERC priorities to allow grantees total discretion in
scheduling the conference.
Priority 1: Aging With a Disability
Comment: Research and training on aging with a disability should be
interdisciplinary.
Discussion: An applicant could propose to carry out the RRTC's
research and training activities using an interdisciplinary model. The
peer review process will evaluate the merits of the proposal. However,
NIDRR has no basis to determine that all applicants should be
prohibited from proposing other models.
Changes: None.
Comment: The priority should include health promotion and wellness
programs in the second activity on reducing aging's impact on health
status.
Discussion: An applicant could propose to include health promotion
and wellness programs in the second activity of the priority. The peer
review process will evaluate the merits of the proposal. However, NIDRR
has no basis to determine that all applicants should be required to
include health promotion and wellness programs in their efforts to
address reducing aging's impact on health status.
Changes: None.
Comment: The fourth activity on psychosocial adjustment should be
expanded to include community integration in order to address broader
community resource issues such as access to health care and employment.
Discussion: NIDRR agrees that expanding the scope of the fourth
activity to include community integration will enable the RRTC to
address a wider range of important issues. It will also provide
applicants with more discretion to propose activities that address a
wider range of issues related to psychosocial adjustment.
Changes: Community integration has been added to the fourth
activity of the priority.
[[Page 32527]]
Priority 2: Arthritis Rehabilitation
Comment: The RRTC should study managed care in order to enable
persons with expertise in arthritis to contribute to this burgeoning
field of interest.
Discussion: The impact of managed care on the provision of services
to persons with arthritis is an important area. However, it is not
feasible, considering the complexity of the topic, for the RRTC to
address managed care in addition to the current requirements in the
priority.
Changes: None.
Priority 3: Stroke Rehabilitation
Comment: The RRTC should address reducing the incidence and impact
of coexisting and secondary conditions on stroke survivors. These
conditions are not only common in all age groups of stroke survivors,
but also have a significant impact on the course, care, and outcome of
stroke rehabilitation efforts.
Discussion: NIDRR agrees that including coexisting and secondary
conditions within the activities of the RRTC constitutes a more
comprehensive approach to stroke rehabilitation.
Changes: The first activity has been revised to include coexisting
and secondary conditions.
Rehabilitation Engineering and Research Centers--General
Comment: The priorities should be broadened to include a field-
initiated activity for grants smaller in scope.
Discussion: NIDRR's field-initiated projects competition is held
annually. Therefore, including a field-initiated activity within an
RERC priority is unnecessary.
Changes: None.
Priority 4: Prosthetics and Orthotics (P and O)
Comment: The RERC should be required to address the human-
technology interface.
Discussion: The second activity requires the RERC to address
selecting and fitting prosthetic and orthotic devices. The human-
technology interface is a required step in this process. Therefore, an
additional requirement addressing human-technology interface is
unnecessary.
Changes: None.
Priority 5: Wheeled Mobility
Comment: Three commenters suggested broadening the priority to
address new technologies in the area of wheeled mobility. One commenter
specifically suggested requiring the RRTC to investigate advanced
electric powered wheelchair controls and develop new wheelchair
technology to increase performance and accessibility while reducing
cost and preventing secondary disability.
Discussion: NIDRR agrees that research on new technologies in the
area of wheeled mobility is needed. NIDRR believes that applicants
should have as much discretion as possible in this emerging area. Under
the revised priority (see below) an applicant could propose to
investigate advanced electric powered wheelchair controls or develop
new wheelchair technology to increase performance and accessibility
while reducing cost and preventing secondary disability. The peer
review process will evaluate the merits of these proposals. NIDRR also
has no basis to determine that all applicants should be required to
investigate advanced electric powered wheelchair controls or develop
new wheelchair technology to increase performance and accessibility
while reducing cost and preventing secondary disability.
Changes: The priority has been revised to require the RRTC to
develop and evaluate new technologies in the area of wheeled mobility.
Comment: Thirteen commenters expressed concern about the need for
continued research activities related to wheelchair transportation
safety issues.
Discussion: NIDRR agrees with the commenters that issues remain to
be addressed in regard to wheelchair transportation safety. An
applicant could propose to include wheelchair transportation safety
issues in the activity to develop and evaluate new technologies in the
area of wheeled mobility. The peer review process will evaluate the
merits of the proposal. However, NIDRR has no basis to determine that
all applicants should be required to carry out research on wheelchair
transportation safety issues.
Changes: None.
Comment: The fifth activity should be expanded to include voluntary
performance standards for wheelchairs, and the sixth activity should be
expanded to include outcome measurement tools or quantifying seating
and mobility interventions.
Discussion: Expanding the fifth and sixth activities as suggested
by the commenter is not necessary because an applicant could propose
the commenter's suggestions under the new requirement to develop and
evaluate new technologies in the area of wheeled mobility.
Changes: None.
Comment: Researchers have recently demonstrated wheelchair control
systems that augment human motion control. Given the relevance of this
area of research and the success of state-of-the-art prototypes, it is
recommended that the commercialization of augmented wheelchair control
systems be a requirement of this priority.
Discussion: The RERC can carry out research on augmented wheelchair
control systems, however, commercialization of augmented wheelchair
control systems is outside the scope and purpose of the RERC.
Changes: None.
Comment: It may be unclear to applicants why it is important to
integrate external devices with wheelchairs. The priority could be
improved by adding the word ``control'' to the second activity.
Discussion: The background section elaborates on the importance of
control systems for external devices. NIDRR agrees that including
``control'' in the second activity will clarify the purpose of the
second activity.
Changes: The second activity has been revised to include control of
external devices.
Comment: A fundamental need before outcome measures can be
developed for wheelchair seating is to develop the standardized
measures and terminology that will define and allow communication about
the quantification of the wheelchair seated posture. The sixth activity
regarding the development and evaluation of outcome measurement tools
should be revised to include standardized measures and terminology of
seated posture.
Discussion: An applicant could propose to develop and evaluate
standardized measures and terminology of seated posture under the sixth
activity of the priority. The peer review process will evaluate the
merits of this proposal. However, NIDRR has no basis to determine that
all applicants should be required to develop and evaluate standardized
measures and terminology of seated posture.
Changes: None.
Comment: The RERC should be required to investigate injury risk and
assess technologies and strategies that will enhance wheelchair safety.
Discussion: An applicant could propose to investigate injury risk
and assess technologies and strategies that will enhance wheelchair
safety under the new requirement to develop and evaluate new
technologies in the area of wheeled mobility. The peer review process
will evaluate the merits of the proposal. However, NIDRR has no basis
to determine that all applicants should be required to investigate
injury risk and assess technologies and strategies that will enhance
wheelchair safety.
Changes: None.
[[Page 32528]]
Priority 6: Technology Transfer
Comment: The background section should be expanded to discuss
technology commercialization and technology utilization.
Discussion: Commercialization and technology utilization are key
components of technology transfer. Commercialization and technology
utilization are referred to in a variety of ways throughout the
background section.
Changes: None.
Comment: The words ``technology transfer'' should be added to the
third and fourth activities in order to clarify that the RERC is
expected to address the continuum of technology transfer activities.
Discussion: The third and fourth activities address specific
development, evaluation, design, and dissemination tasks. It is not
necessary to include the words ``technology transfer'' in order to
understand these requirements or ensure that the continuum of
technology transfer activities will be pursued by applicants.
Changes: None.
Comment: The RERC should be required to carry out demonstration
activities. Technology transfer needs to be demonstrated using
assistive technology products that are consumer and market responsive.
Discussion: As reflected in the priority and the selection criteria
that will be used to evaluate applications, the RERC is required to
carry out research, development, training, dissemination, utilization,
and technical assistance activities. Having met the requirements to
complete these activities, an applicant could propose to carry out
related demonstration activities. However, NIDRR has no basis to
determine that all applicants should be required to carry out
demonstration activities.
Changes: None.
Proposed Priority 7: Telerehabilitation
Comment: Four commenters feel the priority should be broadened to
include the development of strategies and techniques necessary to
provide and monitor vocational rehabilitation services.
Discussion: The priority purposefully refers to ``rehabilitation
services'' in general in order to be applicable to all types of
rehabilitation services. Therefore, the RERC is expected to address
vocational rehabilitation services as well as other rehabilitation
services.
Changes: None.
Comment: The four activities do not contain the words ``research,''
``engineering,'' or ``science'' and could be misinterpreted as simply
calling for demonstrations of existing technologies without
significantly advancing the state-of-the-art. The wording of the
priority should be modified to strengthen the commitment to scientific
and engineering investigation.
Discussion: NIDRR agrees that the priority should be revised in
order to reinforce the RERC's commitment to scientific and engineering
investigation.
Changes: An investigation requirement has been added to the second
and third activities.
Comment: A new activity should be added to require the RERC to
serve as the national focal point for telerehabilitation and virtual
reality related to individuals with disabilities and to maintain links
with the much larger international and national telemedicine and
virtual reality communities.
Discussion: RERCs are national in scope and expected to take a
leadership position within the field. The RERC is also expected to
communicate and coordinate with other entities carrying out related
research and development activities. Unless the RERC could not achieve
its purposes without a requirement to coordinate or collaborate with
specific entities, NIDRR provides applicants with the discretion to
propose the partners for coordination and collaboration activities.
Changes: None.
Comment: Two commenters indicated that, too often, patients in
rural areas who experience communication disorders are unable to obtain
state-of-the-art speech and language therapy in geographically
accessible centers. These commenters suggested that scope of this RERC
should be expanded to include the rehabilitation of individuals with
communication disorders in rural settings.
Discussion: Unless noted otherwise in a priority, any NIDRR-funded
project or center must address the needs of all persons with
disabilities, including those with communication disorders.
Changes: None.
Comment: Two commenters indicated that the background statement
mentions ``spinal cord injury, stroke, and traumatic brain injury'' as
examples of disabling conditions to which telerehabilitation techniques
might usefully be applied. To avoid ambiguity and an unnecessarily
narrow mandate, the background statement should be broadened to include
a broad range of disabilities.
Discussion: The fact that background statement mentions ``spinal
cord injury, stroke, and traumatic brain injury'' as examples of
disabling conditions to which telerehabilitation techniques might
usefully be applied, is not intended to suggest that the RERC limit its
activities to these conditions. This RERC is expected to address the
rehabilitation needs of all persons with disabilities.
Changes: None.
Comment: Five commenters indicated the priority focuses too
narrowly on individuals who lack easy access to outpatient
rehabilitation care due to geographic remoteness. The commenters
pointed out that many people in metropolitan areas have geographical
access problems due, in part, from a lack of accessible transportation.
The commenters suggest that the first activity be broadened to include
all consumers of rehabilitation services who encounter barriers to
receiving continued care through conventional means.
Discussion: The communication systems that the RERC will identify
and evaluate to connect comprehensive rehabilitation facilities with
therapists, individuals, and family members living in remote areas will
be applicable to all consumers of rehabilitation and settings,
including metropolitan areas.
Changes: None.
Comment: Two commenters feel the last sentence of the third
paragraph in the background statement appears to limit monitoring
capabilities to only video and audio technologies. The commenters
suggested that the sentence should be broadened to include a variety of
promising sensor technologies.
Discussion: The RERC will include sensor technologies in its
activities, and these technologies are referenced in the second
paragraph of the background statement.
Changes: None.
Comment: The word ``diagnostic'' in the second activity is too
limiting and should be replaced with either ``assessment'' or
``evaluation.''
Discussion: NIDRR agrees that ``assessment'' is a more appropriate
term.
Changes: The second activity has been revised by substituting the
word ``assessment'' for ``diagnostic.''
Comment: The second activity should be expanded beyond
rehabilitation to include post-rehabilitation health services.
Discussion: Having met all the requirements of the priority, an
applicant could propose to include post-rehabilitation health services
within the scope of its activities. The peer review process will
evaluate the merits of the proposal. However, NIDRR has no basis
[[Page 32529]]
to determine that all applicants should be required to include post-
rehabilitation health services within the scope of the RERC's
activities.
Changes: None.
Comment: Managed care will have a major impact on the extent to
which telerehabilitation will be used once these technologies are
developed. Therefore, this RERC should be required to coordinate its
activities with the NIDRR funded RRTC on Managed Health Care for
Individuals with Disabilities.
Discussion: An applicant could propose to coordinate with the RRTC
on Managed Health Care. The peer review process will evaluate the
merits of this proposal. However, it is not necessary for the RERC to
coordinate with the RRTC on Managed Health Care in order to carry out
its purposes.
Changes: None.
Comment: Three commenters suggested that the priority should
identify relevant rehabilitation disciplines such as occupational
therapy, physical therapy, speech pathology and nursing. A fourth
commenter indicated that nurses are the most common caregivers in the
home setting and suggested that nurses should be included in the first
activity.
Discussion: NIDRR agrees that the use of the term ``therapists'' in
the first activity may be interpreted narrowly. ``Providers of
rehabilitation services'' is a broader category would clearly include
nurses.
Changes: The first activity has been revised by substituting
``providers of rehabilitation services'' for ``therapists.''
Comment: In regard to the second and fourth activities, the RERC
should provide a testbed environment to demonstrate concepts prior to
investment, including simulating telecommunication links to test
bandwidth performance and simulating new rehabilitation strategies and
devices in virtual reality software. Specifically the RERC should:
demonstrate the application of tools via pilot tests with regional
rehabilitation service partners; demonstrate the application of
technology to establish on-line rehabilitation services communities;
and provide collaborative virtual reality capabilities establishing on-
line communities via the Internet to provide job postings,
rehabilitation news, tips and best practices, virtual reality 3D chat
rooms, push technology features to reach remote users, and education
and training simulations.
Discussion: All of the proposals contained in this comment are
within the scope of the priority and could be proposed by an applicant
to achieve the purposes of the second and fourth activity. The peer
review process will evaluate the merits of the proposals. There is
insufficient evidence to warrant requiring all applicants to carry out
the activities suggested in the comment.
Changes: None.
Comment: Although telerehabilitation and virtual reality are new
technologies, they have little in common. Virtual reality is a therapy,
while telerehabilitation is a health care delivery and educational
system. The fourth activity requiring the RERC to investigate the use
of virtual reality should be deleted from this priority. Virtual
reality deserves a separate priority.
Discussion: NIDRR disagrees that virtual reality is a therapy.
NIDRR believes that it is an emerging technology with significant
therapeutic potential. In light of substantial work that is being
supported elsewhere in the public and private sector on virtual reality
applications, NIDRR believes that authorizing this RERC to undertake
one activity investigating the use of virtual reality in rehabilitation
is a proper course of action.
Changes: None.
Comment: The RERC should be required to implement the concepts of
universal design and universal access in all facets of their research.
Discussion: NIDRR supports the promotion of universal design and
universal access through a variety of research, training, technical
assistance, and information dissemination activities. An applicant
could propose to carry out its activities consistent with concepts of
universal design and access. The peer review process will evaluate the
merits of this approach. However, NIDRR declines to require all
applicants to implement these concepts because the RERC's purpose could
be achieved without adherence to these concepts.
Changes: None.
Comment: The RERC should not only research strategies that employ
remote technologies to deliver services, but also strategies to collect
and analyze process and outcome data over time.
Discussion: NIDRR agrees with the commenter and points out that the
RERC is required to develop and evaluate these strategies under the
third activity in the priority. No further changes are necessary in the
priority.
Changes: None.
Comment: Although some systems may already be in place to
facilitate the delivery of telerehabilitation services, new
technologies are emerging every day. The word ``develop'' should be
included in the first activity.
Discussion: NIDRR agrees that the RERC should not only identify and
evaluate, but also develop communications systems under the first
activity in the priority.
Changes: The priority has been revised to require the RERC to
develop communications systems under the first activity in the
priority.
Comment: The priority does not mention the potential that
telecommunication technology has in promoting organizational and
multidisciplinary team collaboration. NIDRR should place an emphasis on
evaluation of telecommunications technology in fostering collaboration.
Discussion: An applicant could propose to place an emphasis on
telecommunications technology that fosters collaboration. The peer
review process will evaluate the merits of this emphasis. However,
NIDRR has no basis to determine that all applicants should be required
to place an emphasis on telecommunications technology that promotes
collaboration.
Changes: None.
Comment: Given that shorter lengths-of-stay are becoming common
place throughout the rehabilitation community, the RERC should be
required to explore techniques for extending rehabilitation programs in
the home and other settings (e.g., day care centers, senior centers,
independent living centers).
Discussion: An applicant could propose to explore techniques for
providing rehabilitation services through telerehabilitation in a
variety of settings, including day care centers, senior centers, and
independent living centers. The peer review process will evaluate the
merits of this proposal. However, NIDRR has no basis to determine that
all applicants should be required to propose extending rehabilitation
programs through telerehabilitation in a variety of settings, including
day care centers, senior centers, and independent living centers.
Changes: None.
Comment: Virtual reality is a costly technology and activities
related to virtual reality development and testing could engage a
disproportionately high portion of the resources available for this
RERC. A relatively modest project involving applications of virtual
reality could easily account for all of the funds proposed to support
this RERC. It would be disappointing to see a focus on such a high
profile application deter development of lower cost technologies that
may have more immediate and broader payoff.
Discussion: NIDRR recognizes that the emerging field of virtual
reality could
[[Page 32530]]
easily overwhelm the resources of the RERC and has purposefully limited
the fourth activity to research related to virtual reality rather than
development.
Changes: None.
Comment: Care should be taken to ensure that technologies developed
under this RERC can be used in settings without state-of-the-art
hardware and software. Developing technology applications that take
advantage of the existing communication infrastructure has the
potential to put state-of-the-art rehabilitation services within reach
of all people, regardless of the wealth of the community.
Discussion: NIDRR agrees that the RERC should develop technologies
with the broadest application. The selection criteria used in the peer
review process will address this issue by evaluating the impact of the
proposed activities on the target population.
Changes: None.
Comment: The priority should be broadened to require the RERC to
study policy issues (e.g., reimbursement issues and selection criteria)
that will affect the implementation of telerehabilitation.
Discussion: NIDRR agrees that there are policy issues that will
affect the implementation of telerehabilitation. An applicant could
propose to integrate policy issues into the first, third, and fourth
activities of the priority. The peer review process will evaluate the
merits of the proposal. However, there is insufficient evidence to
require that all applicants address policy issues related to the
implementation of telerehabilitation.
Changes: None.
Comment: The third activity appears to focus on remote therapeutic
interventions while the second activity focuses on evaluation tools. Is
this interpretation correct?
Discussion: The commenter's interpretation is correct.
Changes: None.
Rehabilitation Research and Training Centers
The authority for RRTCs 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 that
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.
Description of Rehabilitation Research and Training Centers
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 these individuals.
RRTCs conduct coordinated, integrated, 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.
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.
RRTCs disseminate materials in alternate formats to ensure that
they are accessible to individuals with a range of disabling
conditions.
NIDRR encourages all Centers to involve individuals with
disabilities and individuals from minority backgrounds as recipients of
research training, as well as clinical training.
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 RRTC Requirements
The following requirements apply to these RRTCs pursuant to these
absolute priorities unless noted otherwise. An applicant's proposal to
fulfill these requirements will be assessed using applicable selection
criteria in the peer review process.
The RRTC must provide: (1) applied research experience; (2)
training on research methodology; and (3) training to persons with
disabilities and their families, service providers, and other
appropriate parties in accessible formats on knowledge gained from the
Center's research activities.
The RRTC must develop and disseminate informational materials based
on knowledge gained from the Center's research activities, and
disseminate the materials to persons with disabilities, their
representatives, service providers, and other interested parties.
The RRTC must involve individuals with disabilities and, if
appropriate, their representatives, in planning and implementing its
research, training, and dissemination activities, and in evaluating the
Center.
The RRTC must conduct a state-of-the-science conference and publish
a comprehensive report on the final outcomes of the conference. The
report must be published in the fourth year of the grant.
Priorities
Under 34 CFR 75.105(c)(3), the Secretary gives an absolute
preference to applications that meet the following priorities. The
Secretary will fund under this competition only applications that meet
one of these absolute priorities.
Priority 1: Aging with a Disability
Background
Advances in medical care, rehabilitation technology, and
rehabilitative treatment have made aging a routine event for persons
with a disability. The rapid increase in the number of people with a
physical disability who are growing older has been well documented
(McNeil, J., ``Americans With Disabilities,'' U.S. Bureau of the
Census, Statistical Brief,
[[Page 32531]]
SB/94-1, 1994). Many persons aging with a disability face significant
new challenges to their health, daily functioning, and independence.
These challenges may come from onset of chronic conditions such as
hypertension or from secondary conditions such as post-polio. For
example, approximately 70 percent of people with polio experience some
form of ``post-polio syndrome,'' a condition that impairs functioning
(Halstead, L., ``Assessment Differential Diagnosis for Post-Polio
Syndrome,'' Orthopedics, 14, pgs. 1209-1222, 1991).
The problems resulting from aging with a disability can be grouped
into four areas: (1) Decline in health status due to onset of new
chronic conditions or development of secondary conditions; (2) decline
in functional abilities due to changed health status; (3) difficulty
maintaining psychological well-being and life satisfaction; and (4)
diminished capacity of family and community support networks to
accommodate changes associated with aging with a disability.
Aging with a disability is a complex phenomenon, influenced by both
normal and injury-related biological processes, by medical and
rehabilitative developments, and by changing social, cultural and
physical environments (De Vivo, M., et al., ``Causes of Death During
the First 12 Years After Spinal Cord Injury,'' Archives of Physical
Medicine and Rehabilitation, 74, pgs. 248-254, 1991). Although some
progress has been made in systematically assessing the ``natural
course'' of aging with a physical disability (Whiteneck, G., ``Learning
from Empirical Investigations,'' Perspectives on Aging with Spinal Cord
Injury, pgs. 23-27, 1992), this work is not complete.
Persons aging with a disability face significant health problems
because of the onset of new conditions associated with the aging
process itself and potentially complicated by the disability condition.
Research suggests that chronic diseases such as cardiovascular
illnesses and diabetes occur at earlier than expected ages and in
substantially higher percentages among persons who acquired a
disability in early life (Pope, A. and Flemming, C., Disability in
America: Toward a National Agenda for Prevention, pg. 191, 1991).
Significant bone loss (osteoporosis) is higher in people with complete
spinal cord lesions than in age-matched controls (Garland, D., et al.,
``Osteoporosis After Spinal Cord Injury,'' Journal of Orthopedic
Research, 10, pgs. 371-378, 1992). Other age-related health problems
may be impairment-specific secondary conditions such as hip
dislocations in people with cerebral palsy or respiratory problems for
persons with post-polio syndrome. One study found that 50 percent of
people with a 40-year history of cerebral palsy had severe joint, back
or neck pain (Murphy, K., ``Medical and Social Issues in Adults with
Cerebral Palsy, The California Study,'' Developmental Medicine and
Child Neurology, Vol. 37, pgs. 1075-1084, 1995).
Fatigue, loss of strength, increased pain, and other health-related
changes associated with aging may affect function so that capacity to
perform activities of daily living (ADL) (e.g., mobility, bathing, and
transfers), is diminished. Fatigue and weakness may affect 60 to 70
percent of people with spinal cord injury (SCI) or post-polio (Gerhart,
K., et al., ``Long-term Spinal Cord Injury: Functional Changes Over
Time,'' Archives of Physical Medicine and Rehabilitation, 74, pgs.
1030-1035, 1993).
In addition to facing new physical challenges, some people aging
with a disability also develop psychological conditions. In the general
aging population, depression is often an unrecognized corollary of the
aging process (Lebowitz, B., et al., ``Diagnosis and Treatment of
Depression in Late Life,'' Journal of the American Medical Association,
278 (14), pgs. 1186-1190, 1997). At least one study has found that
between 25 and 40 percent of persons aging with a disability show high
distress, especially as expressed in symptoms of depression (Fuhrer,
M., et al., ``The Relationship of Life Satisfaction to Impairment,
Disability and Handicap Among Persons with Spinal Cord Injury Living in
the Community,'' Archives of Physical Medicine and Rehabilitation, 73,
pgs. 552-557, 1992). Treatment of depression for persons aging with a
disability is difficult to obtain because of the failure of health
professionals to recognize depression in persons aging with a
disability (Krause, J. and Crewe, N., ``Chronological Age Time Since
Injury and Time of Measurement: Effect on Adjustment After Spinal Cord
Injury,'' Archives of Physical Medicine and Rehabilitation, 72, pgs.
91-100, 1991).
Families may experience new stresses because of age-related
conditions acquired by their family members with disabilities. In
addition, aging of family caregivers may affect their ability to
continue caregiving roles, thus reducing the ability of a person aging
with a disability to remain in the family setting. The importance of
this issue is reinforced by the fact that family caregivers provide
most of the personal assistance to persons with disabilities (Nosek,
M., ``Life Satisfaction of People with Physical Disabilities:
Relationship to Personal Assistance, Disability Status and Handicap,''
Rehabilitation Psychology, 40, pgs. 191-197, 1995). Helping families
cope can include options like expanding respite care or training
related to age-related changes.
The increase in the numbers of persons aging with a disability has
increased the need for rehabilitation personnel trained in providing
services to this population. Serving an aging population may also
require new treatment and other service delivery models. Research on
effective accommodations, including the use of assistive technology,
for this aging population has been limited.
Priority 1
The Secretary will establish an RRTC on Aging with a Disability to
promote the health, functional abilities, psychological well-being, and
independence of persons aging with a disability. The RRTC shall:
(1) Investigate the natural course of aging with a disability;
(2) Identify, develop, and evaluate methods to reduce aging's
impact on health status, including onset of new chronic conditions and
secondary conditions associated with the primary disability;
(3) Identify, develop, and evaluate rehabilitation techniques,
including the effective use of assistive technology, to maintain
functional independence;
(4) Investigate and evaluate methods to improve community
integration and psychosocial adjustment; and
(5) Conduct studies to identify the extent to which aging affects
the ability of families to support persons aging with a disability in
family and community settings and evaluate strategies that will enhance
the ability of families to cope.
In carrying out these priorities, the RRTC must coordinate with
aging with disability research and demonstration activities sponsored
by the National Center on Medical Rehabilitation Research, the
Department of Veterans Affairs, the Social Security Administration, the
Health Care Financing Administration, and the RRTCs on Health Care for
Individuals with Disabilities--Issues in Managed Health Care, Aging
with Spinal Cord Injury, and Aging with Mental Retardation, the RERC on
Assistive Technology for Older Persons with Disabilities, and other
entities carrying out related research or training activities.
[[Page 32532]]
Priority 2: Arthritis Rehabilitation
Background
``Arthritis'' means joint inflammation and encompasses a large
family of more than 100 so-called rheumatic diseases that can affect
people of all ages. The prevalence of many of these diseases tends to
increase with age and several occur predominantly in women; others are
more common in men. These diseases can affect joints, muscles, tendons,
ligaments, and the protective coverings of some internal organs. Onset
is usually in middle age, and arthritis and musculoskeletal conditions
typically present a cluster of chief complaints including, but not
limited to, pain, muscle impairments, and joint impairments. Arthritis
and musculoskeletal conditions typically result in functional
limitations in ADL. While individuals with arthritis experience most of
their limitations in physical functional activities, the concept of
function has psychological and social dimensions as well (Guccione, A.
A., ``Arthritis and the Process of Disablement,'' Physical Therapy,
Vol. 74, No. 5, May, 1994). For the purpose of this priority, arthritis
and musculoskeletal diseases must include, but are not limited to,
rheumatoid arthritis (RA), osteoarthritis (OA), juvenile rheumatoid
arthritis (JRA), osteoporosis, and fibromyalgia syndrome.
Physical activity may provide significant physical and mental
health benefits for persons with arthritis and musculoskeletal
diseases. In recognizing that regular physical activity can help
control joint swelling and pain, the U.S. Surgeon General's 1996 Report
on Physical Activity and Health, urges people with arthritis to
exercise. The Center for Disease Control and Prevention has indicated
that most persons with arthritis and other rheumatic conditions should
engage in physical activity because exercise helps people with
arthritis maintain normal muscle strength and joint function and
reduces the risk of premature death, heart disease, diabetes, high
blood pressure, colon cancer, depression, and anxiety (Krucoff, C.,
``Taking Action Against Arthritis,'' The Washington Post Health
Section, October 21, 1997). Maintenance of health and wellness is
important when dealing with the problems of arthritis and
musculoskeletal diseases. A number of factors, such as understanding
and managing fatigue and conserving energy, developing relaxation
techniques, participating in exercise programs, and learning about
weight control and proper nutrition, aid in the goal of achieving a
quality of life for individuals who cope with the various problems
encountered.
Pain is a major concern for individuals with arthritis and
musculoskeletal diseases. Pain can affect the ability to work or
function independently in the home or community. The increased
dependency encountered, the thoughts of progressive deformities, and
feelings of frustration through loss of control often lead to
psychosocial difficulties. Rehabilitation interventions can reduce
pain, depression and improve functional abilities.
Musculoskeletal conditions are among the top-ranked conditions
causing limitations in the ability to perform work and reported as
causes of actual work loss. Estimates for prevalence of work
disability, defined as ceasing to work, ranges from 51 percent to 59
percent. Clinical studies have indicated that when RA is in a severe
form, this rate could be as high as 60 percent a decade after diagnosis
(Felts, W. and Yelin, E., ``The Economic Impact of the Rheumatic
Diseases in the United States,'' Journal of Rheumatology, 16, pgs. 867-
884, 1989). Decreased work satisfaction has been reported by persons
with RA; 59 percent are unable to maintain gainful employment. In
addition, patients with RA are significantly more likely to have lost
their job or to have retired early due to their illness, and are the
most likely to have reduced their work hours or stopped working
entirely due to their illness (Gabriel S. E., et al., ``Indirect and
Nonmedical Costs Among People with RA and OA Compared with Nonarthritic
Controls,'' Journal of Rheumatology, 24(1), pgs. 43-48, January, 1997).
Reasonable job accommodations for people with arthritis and
musculoskeletal diseases to manage fatigue, stress, job performance
issues, allowances for medical treatments and individual-related
modifications are areas for employers to consider.
More than 200,000 children in the U.S. are affected with some form
of arthritis (Cassidy, J. T., et al., ``Juvenile Rheumatoid
Arthritis,'' Textbook of Pediatric Rheumatology, pgs. 133-233, 1995).
JRA is the most common childhood connective tissue disease (Chaney, J.
and Peterson, L., Journal of Pediatric Psychology, Vol. 14, No. 3,
1989). JRA affects the physical, psychological and social development
of children and adolescents. Assessing needs and developing strategies
to aid in the promotion of improved medical, educational, psychosocial,
and vocational services is essential with this population.
Priority 2
The Secretary will establish an RRTC on Arthritis Rehabilitation to
improve the functional abilities and promote the independence of
individuals with arthritis and musculoskeletal diseases. The RRTC
shall:
(1) Identify, develop, and evaluate exercise and fitness programs;
(2) Identify, develop, and evaluate rehabilitation interventions to
increase psychological well-being and reduce pain;
(3) Identify, develop, and evaluate job accommodations to maintain
employment; and
(4) Identify, develop, and evaluate programs to maintain health and
wellness.
In carrying out the purposes of the priority, the RRTC must:
Address the needs of children and youth; and
Coordinate with arthritis activities sponsored by the
National Institute on Arthritis and Musculoskeletal and Skin Diseases,
the National Center for Medical Rehabilitation Research, and other
entities carrying out related research or training activities.
Priority 3: Stroke Rehabilitation
Background
In the U.S., there are approximately three million stroke survivors
and 400,000 to 500,000 new or recurrent stroke cases annually
(Gorelicj, P., ``Stroke Prevention,'' Archives of Neurology, 52(4),
pgs. 347-355, 1995). Stroke survivors are the largest population in
rehabilitation hospitals, and an estimated $30 billion is spent on
stroke treatment each year (Alberts, M., et al., ``Hospital Charges for
Stroke Patients,'' Stroke, 27 (10) pgs. 1825-1828, 1996). Previous
NIDRR-funded stroke rehabilitation research has focused on prevention
and treatment of secondary conditions of stroke; enhancing functional
capacity following stroke; improving social and community functioning;
and studying the natural history of impairment, disability, and quality
of life after stroke.
Rehabilitation goals for stroke patients focus on maximizing
physical and psychological function, teaching patients about prevention
of recurrent stroke, and working with family members to facilitate
integration of the person recovering from stroke back into family and
community settings. Stroke patients potentially face a number of
functional problems resulting from the paralysis, dysphagia,
neurological, and other health-related sequelae of stroke.
[[Page 32533]]
Higher order cognitive deficits, such as incomprehension and short-
term memory loss, have been shown to have a primary role in predicting
rehabilitation length of stay, functional outcome and long-term care
needs of stroke survivors. Early, comprehensive assessment of cognitive
deficits has been shown to play a significant role in effecting better
rehabilitation outcomes (Galski, T., et al., ``Predicting Length of
Stay, Functional Outcome, and Aftercare in the Rehabilitation of Stroke
Patients. The Dominant Role of Higher-Order Cognition,'' Stroke, 24
(12), pgs. 1794-1800, December, 1993).
Endurance exercise is recognized as an important component of
rehabilitation for stroke patient recovery of sensorimotor function.
The ability of stroke patients to participate in exercise is
compromised because they have lowered motor functional ability as a
result of both reduced oxidative capacity and reduced availability of
motor units. Traditional methods of measuring aerobic capacity are not
appropriate for this population, nor are exercise training protocols
that do not reflect stroke patient capacity for exercise (Potempa, K.,
et al., ``Benefits of Aerobic Exercise After Stroke,'' Sports Medicine,
21(5), pgs. 337-346, 1996).
Changes in personality, mood, and temperament can be confusing and
distressing for stroke survivors and their caregivers. Depression can
be a significant problem for both survivors and caregivers (Kumar, A.,
et al., ``Quantitative Anatomic Measures and Comorbid Medical Illness
in Late-life Major Depression,'' American Journal of Geriatrics
Psychiatry, 5(1), pgs. 15-25, 1997). Effective treatment of
psychological and behavioral problems may require more standardized
approaches that incorporate psychopharmacological, behavioral, and
psychological interventions.
Although stroke is predominantly a phenomenon that strikes persons
aged 65 and over, five percent occur in persons under age 45.
Individuals in this age cohort are generally employed, have a longer
life expectancy than older stroke patients, and generally have better
underlying health status and incur less brain injury related to the
stroke (Ferro, J. and Crespo, M., ``Prognosis After Transient Ischemic
Attack and Ischemic Stroke in Young Adults,'' Stroke, (8), pgs. 1611-
1616, August, 1994). Rehabilitation for younger patients may emphasize
vocational options, sexuality, and social functioning (Roth, E., ``From
the Editor,'' Topics in Stroke Rehabilitation--The Young Stroke
Survivor, Vol. 1, pg. vi, Spring, 1994). In addition, complications
such as drug use or pregnancy may complicate rehabilitation strategies
(Meyer, J., et al., ``Etiology and Diagnosis of Stroke in the Young
Adult,'' Topics in Stroke Rehabilitation--The Young Stroke Survivor,
Vol. 1, pgs. 1-14, Spring, 1994).
Persons at the other end of the age spectrum, those over age 75 who
comprise 41.8 percent of stroke rehabilitation patients (Personal
communication with Samuel J. Markello, Ph.D. and Carl V. Granger, M.D.,
Director, National Rehabilitation Outcomes Database, maintained by the
Uniform Data System for Medical Rehabilitation, University of Buffalo,
January, 1998), are at risk for poor rehabilitation outcomes possibly
because of the effects of frailty and co-morbid disease (Falconer, J.,
et al., ``Stroke Inpatient Rehabilitation: A Comparison Across Age
Groups,'' Journal of the American Geriatric Society, 42(1), pgs. 39-44,
January, 1994). In this population, presence of a healthy and caring
spouse, bladder and bowel continence, and ability to feed oneself have
predicted better outcomes (Reddy, M. and Reddy, V., ``After a Stroke:
Strategies to Restore Function and Prevent Complications,'' Geriatrics,
52(9), pgs. 59-62, September, 1997).
Prevention of stroke recurrence is increasingly a goal of medical
rehabilitation stroke treatment programs (Gorelick, P., ``Stroke
Prevention,'' Archives of Neurology, 52(4), pgs. 347-355, April, 1995).
Prevention methods include teaching individuals to monitor their blood
pressure, raising awareness of the importance of nutrition and
exercise, and educating family members about stroke.
Medical research shows promise for dramatically improving the
diagnosis and treatment of stroke in acute care settings. New drug
therapies may significantly limit the impact of the initial stroke.
Better diagnostic tools, such as using magnetic resonance imaging (MRI)
to determine stroke type, size, and location, will result in earlier
diagnosis and treatment (Centofanti, M., ``Fighting Back Against Brain
Attack,'' Johns Hopkins Magazine, pgs. 18-24, November, 1997). The
consequences of improved initial stroke treatment for rehabilitation
treatment and service delivery mechanisms are unknown.
Changes in financing and service delivery models of stroke
rehabilitation have created different rehabilitation treatment setting
options for stroke patients. Increasingly, stroke patients are
receiving rehabilitation in post-acute service settings (e.g., nursing-
home based rehabilitation programs). As a consequence of these changes,
there are questions about the impact on outcomes of stroke patients.
For instance, how does treatment intensity vary across settings; does
treatment intensity affect outcomes across settings; do population
characteristics differ across settings? Initial research indicates that
outcomes may not differ dramatically when comparing acute to post-acute
rehabilitation settings (Cramer A., et al., ``Outcomes and Costs After
Hip Fracture and Stroke--A Comparison of Rehabilitation Settings,''
JAMA, Vol. 277, pgs. 396-404, 1997); however, knowledge about long-term
outcomes of treatment in these different settings is still
inconclusive.
Another development affecting stroke rehabilitation is
implementation of practice guidelines. In 1996, the Agency for Health
Care Policy and Research published stroke treatment guidelines (Post-
Stroke Rehabilitation: A Quick Reference Guide for Clinicians, Pub. 95-
0663, 1996). These guidelines aim to minimize variation in treatment
across acute care and rehabilitation settings (Ringel, S. and Hughes,
R., ``Evidence-based Medicine, Critical Pathways, Practice Guidelines,
and Managed Care. Reflections on the Prevention and Care of Stroke,''
Archives of Neurology, 53(9), pgs. 867-871, 1996). The rate of adoption
of these guidelines and their impact on rehabilitation service and
outcomes is not yet known.
Priority 3
The Secretary will establish an RRTC for Stroke Rehabilitation to
develop and evaluate rehabilitation approaches to improve stroke
rehabilitation treatment for all patients. The RRTC shall:
(1) Identify, develop, and evaluate rehabilitation techniques to
address coexisting and secondary conditions and improve outcomes for
all stroke patients, giving specific emphasis to rehabilitation needs
of older and younger patient groups and to methods that incorporate
cognition in the treatment protocols;
(2) Develop and evaluate standard aerobic exercise protocols; and
(3) Identify and evaluate methods to identify and treat depression
and other psychological problems associated with stroke;
(4) Determine the effectiveness of stroke prevention education
provided in medical rehabilitation settings;
(5) Evaluate the impact of changes in diagnosis and medical
treatment of stroke on rehabilitation needs;
(6) Evaluate long-range outcomes for stroke rehabilitation across
different treatment settings;
[[Page 32534]]
(7) Evaluate the impact of stroke practice guidelines on delivery
and outcomes of rehabilitation services.
In carrying out the purposes of the priority, the RRTC must:
Collaborate with RRTCs on Health Care for Individuals with
Disabilities--Issues in Managed Health Care, and Aging with a
Disability; and
Coordinate with stroke activities sponsored by the
National Center for Medical Rehabilitation Research, the National
Institute on Neurological Disorders and Stroke, and other entities
carrying out related research or training activities.
Rehabilitation Engineering Research Centers
The authority for RERCs is contained in section 204(b)(3) of the
Rehabilitation Act of 1973, as amended (29 U.S.C. 762(b)(3)). The
Secretary may make awards for up to 60 months through grants or
cooperative agreements to public and private agencies and
organizations, including institutions of higher education, Indian
tribes, and tribal organizations, to conduct research, demonstration,
and training activities regarding rehabilitation technology in order to
enhance opportunities for meeting the needs of, and addressing the
barriers confronted by, individuals with disabilities in all aspects of
their lives. An RERC must be operated by or in collaboration with an
institution of higher education or a nonprofit organization.
Description of Rehabilitation Engineering Research Centers
RERCs carry out research or demonstration activities by:
(a) Developing and disseminating innovative methods of applying
advanced technology, scientific achievement, and psychological and
social knowledge to (1) solve rehabilitation problems and remove
environmental barriers, and (2) study new or emerging technologies,
products, or environments;
(b) Demonstrating and disseminating (1) innovative models for the
delivery of cost-effective rehabilitation technology services to rural
and urban areas, and (2) other scientific research to assist in meeting
the employment and independent living needs of individuals with severe
disabilities; or
(c) Facilitating service delivery systems change through (1) the
development, evaluation, and dissemination of consumer-responsive and
individual and family-centered innovative models for the delivery to
both rural and urban areas of innovative cost-effective rehabilitation
technology services, and (2) other scientific research to assist in
meeting the employment and independent needs of individuals with severe
disabilities.
Each RERC must provide training opportunities to individuals,
including individuals with disabilities, to become researchers of
rehabilitation technology and practitioners of rehabilitation
technology in conjunction with institutions of higher education and
nonprofit organizations.
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 RERC, 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 RERC Requirements
The following requirements apply to the RERCs pursuant to these
absolute priorities unless noted otherwise. An applicant's proposal to
fulfill these requirements will be assessed using applicable selection
criteria in the peer review process.
The RERC must have the capability to design, build, and test
prototype devices and assist in the transfer of successful solutions to
relevant production and service delivery settings. The RERC must
evaluate the efficacy and safety of its new products, instrumentation,
or assistive devices.
The RERC must disseminate research results and other knowledge
gained from the Center's research and development activities to persons
with disabilities, their representatives, disability organizations,
businesses, manufacturers, professional journals, service providers,
and other interested parties.
The RERC must develop and carry out utilization activities to
successfully transfer all new and improved technologies developed by
the RERC to the marketplace.
The RERC must involve individuals with disabilities and, if
appropriate, their representatives, in planning and implementing its
research, development, training, and dissemination activities, and in
evaluating the Center.
The RERC must conduct a state-of-the-science conference and publish
a comprehensive report on the final outcomes of the conference. The
report must be published in the fourth year of the grant.
Priorities
Under 34 CFR 75.105(c)(3), the Secretary gives an absolute
preference to applications that meet the following priorities. The
Secretary will fund under this competition only applications that meet
one of these absolute priorities.
Priority 4: Prosthetics and Orthotics
Background
Prosthetic limbs (also called artificial or replacement limbs)
perform functions previously performed by lost or absent limbs or
portions of limbs. Orthoses (also called braces or anatomical
technology devices) are devices applied to limbs or other parts of the
body that have either lost or impaired function to compensate for
certain differences in anatomical shape or size, muscle weakness, or
paralysis. Appropriately fitted prosthetic and orthotic (P and O)
devices improve functional abilities for work and ADL.
The National Health Interview Survey of 1992 reported a prevalence
in the United States of 102,000 individuals with upper extremity loss
or absence, and 256,000 individuals with lower extremity loss or
absence (LaPlante, M. and Carlson, D., ``Disability in the United
States: Prevalence and Causes, 1992'' Disability Statistics Report No.
7, NIDRR, pg. 29, 1996). The majority of these individuals use or need
prosthetic limbs. It is more difficult to estimate the prevalence of
individuals who use or need orthotic devices because orthoses are used
in a wide variety of disabilities, and unlike loss or absence of a
limb, have not historically been a specific category in national
surveys. However, the National Health Interview Survey on Assistive
Devices (NHIS-AD) of 1990 reported that 3,514,000 individuals in the
United States used anatomical technology devices, categorized as braces
for either the leg, foot, arm, hand, neck, back or other (LaPlante, M.
P., et al., ``Assistive Technology Devices and Home Accessibility
Features: Prevalence, Payment, Need, and Trends,'' Advance Data from
Vital and Health Statistics, National Center for Health Statistics, No.
217, pg. 6, 1992).
According to the Institute of Medicine, there is a lack of a
complete and widely accepted base of scientific and engineering data to
support the process of individuals obtaining the optimum device for
their particular need. The lack of an effective scientific and
theoretical foundation for human gait inhibits the engineering design
of technology to aid ambulation. More
[[Page 32535]]
work is also needed in research and development directed to the
problems of arm and hand replacement (Enabling America: Assessing the
Role of Rehabilitation Science and Engineering, Institute of Medicine
Report, pgs. 111-117, 1997).
The enormous diversity of P and O devices to address many different
muscular, neuromuscular, and skeletal issues, adds to the complexity of
this field and supports the need for quantitative documentation to
improve the process by which individuals obtain the most appropriate P
and O device for their need (Esquenazi, A. and Meier, R. H.,
``Rehabilitation in Limb Deficiency. 4. Limb Amputation,'' Archives of
Physical Medicine and Rehabilitation, Vol. 77, pgs. s18-s28, 1996). For
example, there are approximately 100 commercially available prosthetic
knees capable of being used in transfemoral prostheses (Michael, J. W.,
``Prosthetic Knee Mechanisms,'' Physical Medicine and Rehabilitation:
State of the Art Reviews, Vol. 8, pgs. 147-164, 1994), making it
difficult to evaluate all possible options. The trend in health care
toward evidence-based decision making will require the collection and
analysis of data that may not have occurred in the past (Guyatt, G., et
al., ``Evidence-Based Medicine: A New Approach to Teaching the Practice
of Medicine,'' JAMA, Vol. 268, pgs. 2420-2425, 1992).
Evaluations will play a key role in shaping the services available
in the future (Hailey, D. M., ``Orthoses and Prostheses,''
International Journal of Technology Assessment in Health Care, Vol. 11,
pgs. 214-234, 1995). As more quantitative measurements are being made
at the individual level with respect to device selection, there is a
need to collect data on use of devices by individuals in a uniform
format for archival reference and research purposes. A database that
could be used to evaluate the outcomes of individuals using P and O
devices does not exist. Such a database might include, but would not be
limited to: technical specifications and details of the device;
appropriate performance and outcome measures; relevant anthropometric
measurements of the wearer; appropriate medical and demographic data,
and payment information.
The increased attention to prosthetic technology in developing
nations (Day, H. J. B., ``A Review of the Consensus Conference on
Appropriate Prosthetic Technology in Developing Countries,''
Prosthetics and Orthotics International, Vol. 20, pgs. 15-23, 1996)
along with the advanced state of science in many European nations,
provides opportunity and impetus for the development of international
standards in P and O. In addition, increased international exchanges of
both information and technology, as a result of comparative work, are
highly likely to be beneficial to both the United States and other
countries.
Priority 4
The Secretary will establish an RERC on Prosthetics and Orthotics
to strengthen and expand the scientific and engineering basis for the
field, and develop new ways to use information technology that will
ultimately result in delivery of improved service to individuals who
can benefit from prosthetic and orthotic devices. The RERC shall:
(1) Increase the understanding of the scientific and engineering
principles for human locomotion, reaching, prehension, and
manipulation, and incorporate these principles into the design of P and
O devices;
(2) Develop and evaluate a prototype computer-based system to
select the most appropriate P and O device (or combination of devices),
and fit the device to an individual;
(3) Develop a prototype database of individuals using P&O devices
in collaboration with industry including, but not limited to, technical
details of the device, appropriate performance and outcome measures,
relevant anthropometric measurements of the wearer, appropriate medical
and demographic data, and cost and payment information; and
(4) Maintain an international exchange of scientific information
and participate in the development of international standards.
In carrying out these purposes, the RERC must coordinate on
activities of mutual interest with the RERC on Land Mines and other
entities carrying out related research or development activities.
Priority 5: Wheeled Mobility
Background
Approximately 1.4 million Americans use a wheelchair as their
primary source of mobility (Kraus, L., et al., Chartbook on Disability
in the United States, InfoUse, Berkeley, CA, 1996), including
approximately 600,000 Americans who live in skilled nursing facilities
and are over the age of 65 (Shaw, G. and Taylor, S. J., ``A Survey of
Wheelchair Seating Problems of the Institutionalized Elderly,''
Assistive Technology, Vol. 3, RESNA Press, pgs. 5-10, 1991). The number
of Americans who use wheelchairs nearly doubled between 1980 and 1990
while the general population increased by 13 percent during that same
period (LaPlante, M. P., et al., ``Assistive Technology Devices and
Home Accessibility Features: Prevalence, Payment, Need, and Trends,''
Advance Data from Vital and Health Statistics, No. 217, U.S. Department
of Health and Human Services, September, 1992). The number of
wheelchair users increases as a population ages (Ohlin, P., et al.,
``Technology Assisting Disabled and the Older People in Europe,'' The
Swedish Handicap Institute, Stockholm, 1995). As the American
population continues to grow older, the number of individuals who will
require the use of a wheelchair for mobility is expected to increase.
Wheelchairs and wheelchair seating systems have dramatically
improved over the past decade due in part to advances in lightweight,
high-strength materials, improved mechanical designs, and improved
microprocessor control technologies, and more efficient drive train
systems for powered chairs. There are virtually hundreds of options
available to wheelchair users (e.g., frame sizes and designs, castors,
hand rims, seat sizes, and seat backs). Selecting the appropriate
options when either prescribing or purchasing a wheelchair or
wheelchair seating system can be complicated and difficult for
therapists and consumers.
Individuals who use powered wheelchairs often rely on external
devices (e.g., ventilators, augmentative communication devices, and
environmental control systems) for respiratory support or to help them
function during the day. Improvements in electronic technologies have
led to the development of sophisticated wheelchair controllers with
built-in flexibility and adjustability. Typical controllers are based
on microcomputers and allow for the adjustment of parameters (e.g.,
acceleration and deceleration control, speed control, and tremor
dampening) to improve the user's ability to control the wheelchair
safely (Cook, A. M. and Hussey, S. M., Assistive Technologies:
Principles and Practice, pg. 549, 1995). These controllers are also
capable of directly controlling external devices. Most external devices
are made by companies other than wheelchair manufacturers. As a result,
compatibility between external devices and powered wheelchairs is often
problematic.
Wheelchairs and wheelchair seating systems combine to provide
mobility, pressure relief, postural support, deformity management, and
increased comfort, function and tolerance
[[Page 32536]]
(Hobson, D. A., ``Seating and Mobility for the Severely Disabled,''
Rehabilitation Engineering, pgs. 193-252, 1990). Most wheelchair users
are candidates for seating and positioning interventions. Typical
seating systems statically control an individual's posture by
constraining the individual to a fixed position using modular or custom
fit devices and systems such as foam wedges, hand shaped foams, ``foam-
in-place,'' vacuum consolidation, and CAD-CAM (Cook, A. M. and Hussey,
S. M., op. cit., pgs. 237-239). For individuals who have a high degree
of muscle tone or spasticity, staying in a fixed position can be
uncomfortable and cause pressure sores. An alternative to static
seating is dynamic seating. A recent case study in this area of
research looked at the benefits of a dynamic seating system for an
adolescent with cerebral palsy with a high degree of extensor tone.
This system allowed the individual to extend during spasms, then
returned the individual to a functional seating posture upon relaxation
resulting in a reduction of generalized tone and improved posture
(Ault, H. K., et al., ``Design of a Dynamic Seating System for Clients
with Extensor Spasms,'' Proceedings of the RESNA 1997 Annual
Conference, pgs. 187-189, 1997).
Pressure relief is critical for individuals who have little or no
sensation in weight bearing areas, such as persons with spinal cord
injury and some elderly, or those who are unable to shift their weight
to relieve pressure (Bergen, A., et al., Positioning for Function:
Wheelchairs and Other Assistive Technologies, p. 4, 1990). Without
proper pressure relief, individuals are prone to develop pressure sores
(decubitus ulcers) that can result in tremendous costs for treatment
and in time lost from work (Ditunno, J. F., Jr. and Formal, C. S.,
``Chronic Spinal Cord Injury,'' New England Journal of Medicine, Vol.
330, pgs. 550-556, 1994). The incidence for pressure sores has remained
fairly static (Stover, S. L., et al., Spinal Cord Injury: Clinical
Outcomes from the Model Systems, pgs. 109-113, 1995). There are many
factors that contribute to the development of pressure sores. External
forces (i.e., tension, compression, and shear) applied to localized
areas are the primary causes of pressure sores. Other factors affecting
pressure sore development include, but are not limited to, stress,
friction, body size, posture, nutrition, age, blood circulation, and
the microclimate between one's body and the seating surface (Cook, A.
M. and Hussey, S. M., op. cit., pgs. 282-285). Understanding the
interactions between these factors is paramount to improving seating
and positioning systems.
Decisions made during seating evaluations are often subjective in
nature and are based upon observational analyses and past experience of
the therapists involved. There are over 300 commercially available
cushions on the market (HyperABLEDATA, 1997), as well as a myriad of
wheelchair options. Understanding these options and knowing when to use
them is difficult for therapists and consumers. Voluntary performance
standards for seating and clinical measurement devices would allow for
objective comparison of products based upon standardized test results
from each manufacturer.
A number of outcome measurement tools may be used to measure
functional outcomes of individuals during the rehabilitation process.
However, many of these tools do not consider assistive technology
interventions, including seating and mobility, when rating an
individual's overall performance. For example, in order to get a
maximum score using the Functional Independence Measure, the individual
cannot rely on assistive technology; thereby implying that a person
cannot be totally functionally independent if he or she uses assistive
technology devices (Scherer, M. J. and Galvin, J. C., ``An Outcomes
Perspective of Quality Pathways to the Most Appropriate Technology,''
Evaluating, Selecting, and Using Appropriate Assistive Technology, pg.
21, 1996). A number of clinical measurement devices (e.g., pressure
monitoring devices, and seating simulators) may be used in seating and
mobility clinic environments, however, they do not systematically
measure and record outcomes of wheelchair and seating interventions.
Priority 5
The Secretary will establish an RERC on Wheeled Mobility to improve
the efficiency and selection of wheelchairs and wheelchair seating
systems and investigate new seating system strategies including dynamic
seating systems and pressure sore prevention. The RERC shall:
(1) Develop and evaluate strategies that can be used to aid
therapists and consumers in making informed decisions when prescribing
or purchasing new wheelchairs and wheelchair seating systems;
(2) Develop and evaluate strategies in collaboration with industry
to promote the integration of external devices with powered wheelchairs
and the control of these external devices, ensuring their compatibility
and usability;
(3) Develop and evaluate new technologies in the area of wheeled
mobility;
(4) Investigate the viability of dynamic seating systems;
(5) Investigate the factors that contribute to the development of
pressure sores and develop and evaluate tools, devices and strategies
to prevent them from occurring;
(6) Investigate the use of voluntary performance standards for
wheelchair seating devices and clinical measurement devices and, if
appropriate, develop in collaboration with industry strategies to
facilitate the implementation of those standards; and
(7) Develop and evaluate outcome measurement tools for quantifying
seating clinic intervention results.
In carrying out the purposes of the priority, the RERC must
coordinate on activities of mutual interest with all the RRTCs
addressing Spinal Cord Injury, the RRTC on Aging with a Disability, and
other entities carrying out related research or development activities.
Priority 6: Technology Transfer
Background
Technology transfer is a means of capitalizing on and increasing
the value of an initial investment in research of a particular
technology through new applications. Technology transfer also involves
moving conceptualizations and new inventions from a potential
application into a working prototype and, ultimately, into a commercial
product. There has been an increased interest in developing assistive
technology in recent years. Basic research has yielded innovations
developed with the disability population in mind and more generic
applied research has resulted in new ways to transfer existing
technologies initially developed for different purposes into assistive
technology products. In addition, there are an increasing number of
entrepreneurs and inventors developing devices specifically for persons
with disabilities.
Approximately 13 million people with disabilities use assistive
technology devices to assist them with major life activities (Kraus,
L., et al., Chartbook on Disability in the United States, InfoUse,
Berkeley, CA, 1996). Understanding the functional needs of persons with
disabilities, translating those needs into technical solutions,
identifying the markets and determining which technologies may be
successfully transferred into usable assistive technology products is
critical to the
[[Page 32537]]
technology transfer process (Spaepen, A. J., ``Technology Transfer and
Service Delivery in Rehabilitation Technology,'' Journal of
Rehabilitation Sciences, Vol. 4, pgs. 84-87, 1991). The assistive
technology market is expected to grow dramatically over the next two
decades as the American population ages and as the survival rate of
accident victims continues to climb (Federal Laboratory Consortium,
``Federal Laboratory Technologies Enable the Disabled,'' Technology
Transfer Business, Vol. 4, p. 11, 1997).
There are models of technology transfer that are routinely utilized
by government, small businesses, nonprofit organizations, universities
and industry (Rouse, D., ``Technology Identification and Partnership
Development,'' Research Triangle Institute, 1997). These models assume
a market that is identifiable and definable, somewhat homogeneous,
visible, and well-financed. Transferring promising technologies and new
inventions to the assistive technology arena presents unique
challenges. Devices that either have the potential for use by persons
with disabilities, or were invented for consumers with disabilities
often are not successfully commercialized because of the limited number
of potential users or the developer's inexperience and limited
understanding of disabilities and the assistive technology marketplace
(Gilden, D., ``Moving from Naive to Knowledgeable on the Road to
Technology Transfer,'' Technology and Disability, Vol. 7, pgs. 115-125,
1997).
Frequently, inventions and prototypes of devices require
considerable engineering, modification and redesign. The vast majority
of assistive technology companies are very small and have limited
access to knowledge, resources, markets, funds, skills and finance
(Swanson, D., ``Determining the Government's Responsibilities in
Technology,'' Journal of Technology Transfer, Vol. 20 (2), pgs. 3-4,
1995). Companies and entrepreneurs interested in transferring
inventions and existing technologies into new products for persons with
disabilities require technical assistance to make sound and profitable
decisions and to do a better job of analyzing the viability of
potential products.
Proper screening of devices is critical to the assistive technology
transfer process and requires a feasibility study to be performed for
each device prior to any significant investment of time and financial
resources. Typical questions to ask include: Does the device already
exist in some other form? Do consumers have alternate and satisfactory
ways to perform the same function that would negate the need for
another device? Would the required investment justify the development
of the new device? Is the market too small? Are consumers interested in
using the device? (Newroe, B. N. and Oskardottir, A. Y.,
``Identification and Networking of Assistive Technology-Related
Transfer Resources Through the Consumer Assistive Technology Network
(CATN),'' Technology and Disability, Vol. 7, pgs. 31-45, 1997).
Assistive technology evaluation involves activities beyond the
initial screening of new products and innovations. It is important to
identify and include all other stakeholders in the evaluation process
including, but not limited to, technology experts, engineers,
developers, manufacturers, corporations, community organizations,
providers and potential purchasers. In addition to evaluation studies,
it is necessary to provide an estimate of the resources required and of
the product's readiness for commercialization in order to attract a
developer or manufacturer. Safety, reliability, cost, customer
satisfaction and durability must also be measured (Sheredos, S., et
al., ``The Department of Veterans Affairs Rehabilitation Research and
Development Service's Technology Process,'' Technology and Disability,
Vol. 7, pgs. 25-30, 1997).
Most assistive technology devices are considered orphan products
(devices used by very small populations and having limited market
appeal). In anticipation of a products' low volume and unproven market
demand, potential manufacturers and suppliers must be offered a well
researched device prospectus that will act as an incentive for
production. Products incorporating the principles of universal design
are developed with built-in flexibility so they are usable by all
people, regardless of age and ability, at no additional cost (Mace, R.,
et al., ``Accessible Environments: Toward Universal Design,'' Design
Interventions: Toward Universal Design, p. 156, 1991). The evaluation
phase should include an assessment of whether a product may have
universal application, thereby increasing its marketability.
Priority 6
The Secretary will establish an RERC on technology transfer to
facilitate and improve the process of moving new, useful and better
assistive technology inventions and applications of existing
technologies from the prototype phase to the marketplace to benefit
persons with disabilities. The RERC shall:
(1) Identify and evaluate models of technology transfer that are
applicable to assistive technology;
(2) Identify the needs and provide technical assistance, including
engineering design and support, to inventors, entrepreneurs, small
companies, research laboratories, and industry and university labs to
facilitate the transfer of assistive technology with particular
emphasis on orphan products;
(3) Develop and implement methodologies to screen promising
assistive technology and to evaluate the potential for
commercialization, including an assessment of principles of universal
design of prototypes developed by individual inventors, small
businesses and public or private research laboratories for use by
persons with disabilities; and
(4) Design and disseminate protocols for technical, user and market
evaluations of promising inventions and new uses for existing
technologies.
In carrying out the purposes of the priority, the RERC must:
Conduct activities in consultation with industry, public and
private research facilities, small businesses, entrepreneurs,
university-based research laboratories and consumers; and
Provide technical assistance and support to all RERC's on issues
pertaining to technology evaluation and transfer.
Priority 7: Telerehabilitation
Background
One of the most notable changes in the nation's health care system
is a dramatic downward shift in the average length of stay for patients
admitted to rehabilitation hospitals. According to the National Spinal
Cord Injury Statistical Center, the average length of stay for patients
admitted into the Model SCI Care System dropped from 115 days in 1974
to 49 days in 1995 (``Spinal Cord Injury: Facts and Figures at a
Glance,'' National Spinal Cord Injury Statistical Center, University of
Alabama at Birmingham, August, 1997). Individuals living in rural areas
may have less of an opportunity to continue their rehabilitation than
do individuals living in urban settings due to a lack of rehabilitation
outpatient centers in rural regions. Given that individuals are being
discharged earlier in the rehabilitation process, there is tremendous
need for new and innovative therapeutic devices and strategies that can
be used to continue therapy for individuals living in remote settings
who may not have access to outpatient therapy.
For more than 30 years, clinicians, researchers, and others have
been
[[Page 32538]]
investigating the use of advanced telecommunications and information
technologies to improve health care, resulting in the advent of
telemedicine. Telemedicine has a variety of applications including
patient care, education, research, administration and public health
(Telemedicine: A Guide to Assessing Telecommunications in Health Care,
Institute of Medicine Report, National Academy Press, p. 16, 1996). At
least 10 States have established Medicaid payment mechanisms for
medical services provided through telemedicine (U.S. Department of
Commerce, ``Telemedicine Report to Congress,'' January 31, 1997).
Technological advances in medicine, sensor technologies,
telecommunications and information technologies provide unique
opportunities for expanding upon the field of telemedicine to further
develop the field of telerehabilitation. By using technology,
telerehabilitation enables rehabilitation professionals to provide
rehabilitation services to individuals when distance separates the
participants (Temkin, A. J., et al., ``Telerehab: A Perspective of the
Way Technology is Going to Change the Future of Patient Treatment,''
REHAB Management, p. 28, February/March, 1996). Telecommunication and
information technologies used in telemedicine are modernizing medical
rehabilitation services and are beginning to be used in other aspects
of the rehabilitation process. For example, ongoing experiments to
provide effective delivery of therapeutic counseling from the offices
of professional psychologists to clients physically located elsewhere,
using modified video-conferencing techniques, are under study by the
American Psychological Association (Sleek, S., ``Providing Therapy from
a Distance,'' APA Monitor, American Psychological Association, Vol. 28,
No. 8, August, 1997).
Two very important aspects of comprehensive rehabilitation are
education and training. Rehabilitation practitioners work closely with
individuals and family members to enhance their functional abilities,
assist them in adjusting to their disability (Haas, J., ``Ethical
Issues in Rehabilitation Medicine,'' Rehabilitation Medicine:
Principles and Practice, Second Edition, p. 34, 1993), and lessen the
likelihood of secondary complications (Stover, S., et al., Spinal Cord
Injury: Clinical Outcomes from the Model Systems, p. 322, 1995).
Secondary complications from acute trauma, such as spinal cord injury,
stroke, and traumatic brain injury, are a leading cause for re-
hospitalization. One way of reducing the likelihood of contracting
secondary complications is through education, training, and monitoring.
This can be achieved using portable, low-cost communication devices
capable of providing video and audio connection between comprehensive
rehabilitation facilities and individuals living in rural communities.
Those devices can enable individuals to communicate with rehabilitation
professionals while at home or in remote clinical settings, and to
continue with the educational and training components of the
rehabilitation process. These devices also allow physicians and other
clinicians to monitor the progress of these individuals and offer
clinical diagnoses and interventions when appropriate.
Traditional therapeutic interventions include the use of heat,
cold, light, friction, and pressure to facilitate healing and relieve
pain in affected areas. Many of these therapy techniques require costly
equipment and can be used only by trained therapists. Given that
individuals are being discharged earlier in the rehabilitation process,
there is tremendous need for new, innovative and cost-effective
therapeutic devices and strategies that can be used to safely continue
therapy for individuals living in remote settings who may not have
access to comprehensive outpatient rehabilitation therapy.
Virtual reality is an interactive computer-based technology capable
of simulating complex three-dimensional (3-D) environments. The number
of virtual reality applications has risen dramatically over this past
decade and includes flight simulators, 3-D medical imaging
technologies, and entertainment systems (Hayward, T., Adventures in
Virtual Reality, pgs. 41-48, 1993). The benefits of combining virtual
reality with rehabilitation interventions are potentially extensive.
Virtual reality technologies are being used to convert sign language
into speech and to develop barrier-free designs for people with
physical disabilities. Biosensors that provide qualitative and
quantitative data about muscle activity, pressure and movements are
also capable of being integrated into virtual reality systems for use
in rehabilitation.
Priority 7
The Secretary will establish an RERC on telerehabilitation to
identify and develop technologies capable of supporting rehabilitation
services for individuals who do not have access to comprehensive
outpatient rehabilitation services. The RERC shall:
(1) Identify, develop, and evaluate communication systems capable
of connecting comprehensive rehabilitation facilities with providers of
rehabilitation services, individuals and family members living in
remote settings to provide ongoing rehabilitation education and
training services;
(2) Develop, investigate, and evaluate monitoring and assessment
tools that can be used in the provision of rehabilitation services
through telerehabilitation;
(3) Develop, investigate, and evaluate strategies and devices to
provide and monitor therapeutic interventions in remote settings; and
(4) Investigate the use of virtual reality in rehabilitation
including, but not limited to, education, monitoring, diagnosing, and
therapy.
In carrying out the purposes of the priority, the RERC must
coordinate on activities of mutual interest with the RERCs on
Telecommunications and Information Technologies Access, the RRTC on
Rural Rehabilitation Services, and other entities carrying out related
research or development activities.
Electronic Access to This Document
Anyone may view this document, as well as all other Department of
Education documents published in the Federal Register, in text or
portable document format (pdf) on the World Wide Web at either of the
following sites:
http://ocfo.ed.gov/fedreg.htm
http://www.ed.gov/news.html
To use the pdf you must have the Adobe Acrobat Reader Program with
Search, which is available free at either of the preceding sites. If
you have questions about using the pdf, call the U.S. Government
Printing Office at (202) 512-1530 or, toll free at 1-888-293-6498.
Anyone may also view these documents in text copy only on an
electronic bulletin board of the Department. Telephone: (202) 219-1511
or, toll free, 1-800-222-4922. The documents are located under Option
G--Files/Announcements, Bulletins and Press Releases.
Note: The official version of this document is the document
published in the Federal Register.
Applicable Program Regulations: 34 CFR Part 350.
Program Authority: 29 U.S.C. 760-762.
(Catalog of Federal Domestic Assistance Numbers 84.133B,
Rehabilitation Research
[[Page 32539]]
and Training Centers, and 84.133E Rehabilitation Engineering
Research Centers)
Dated: June 8, 1998.
Curtis L. Richards,
Acting Assistant Secretary for Special Education and Rehabilitative
Services.
[FR Doc. 98-15697 Filed 6-11-98; 8:45 am]
BILLING CODE 4000-01-P
