9886 Federal Register / Vol. 62, No. 42 / Tuesday, March 4, 1997 / Notices

DEPARTMENT OF EDUCATION

National Institute on Disability and

Rehabilitation Research

AGENCY: Department of Education.

ACTION: Notice of proposed priorities for

fiscal years 1997–1998 for research and

demonstration projects, rehabilitation

research and training centers, and a

knowledge dissemination and

utilization project.

SUMMARY: The Secretary proposes

priorities for the Research and

Demonstration Project (R&D) Program,

the Rehabilitation Research and

Training Center (RRTC) Program, and

the Knowledge Dissemination and

Utilization (D&U) Program under the

National Institute on Disability and

Rehabilitation Research (NIDRR) for

fiscal years 1997–1998. The Secretary

takes this action to focus research

attention on areas of national need to

improve rehabilitation services and

outcomes for individuals with

disabilities, and to assist in the

solutions to problems encountered by

individuals with disabilities in their

daily activities.

DATES: Comments must be received on

or before April 3, 1997.

ADDRESSES: All comments concerning

these proposed priorities should be

addressed to David Esquith, U.S.

Department of Education, 600

Independence Avenue, S.W., Switzer

Building, Room 3424, Washington, D.C.

20202–2601. Internet: NPP—

ADA@ed.gov

FOR FURTHER INFORMATION CONTACT:

David Esquith. Telephone: (202) 205–

8801. Individuals who use a

telecommunications device for the deaf

(TDD) may call the TDD number at (202)

205–8133. Internet: David—

Esquith@ed.gov

SUPPLEMENTARY INFORMATION: This

notice contains proposed priorities to

establish R&D projects for model

systems for burn injury and traumatic

brain injury, RRTCs for research related

to aging with a spinal cord injury and

severe problem behaviors, and a D&U

project to improve the utilization of

existing and emerging rehabilitation

technology in the State vocational

rehabilitation program.

These proposed priorities support the

National Education Goal that calls for

all Americans to possess the knowledge

and skills necessary to compete in a

global economy and exercise the rights

and responsibilities of citizenship.

The Secretary will announce the final

funding priorities in a notice in the

Federal Register. The final priorities

will be determined by responses to this

notice, available funds, and other

considerations of the Department.

Funding of particular projects depends

on the final priorities, the availability of

funds, and the quality of the

applications received. The publication

of these proposed priorities does not

preclude the Secretary from proposing

additional priorities, nor does it limit

the Secretary to funding only these

priorities, subject to meeting applicable

rulemaking requirements.

Note: This notice of proposed priorities

does not solicit applications. A notice

inviting applications under these

competitions will be published in the

Federal Register concurrent with or

following publication of the notice of the

final priorities.

Research and Demonstration Projects

Authority for the R&D program of

NIDRR is contained in section 204(a) of

the Rehabilitation Act of 1973, as

amended (29 U.S.C. 760–762). Under

this program the Secretary makes

awards to public agencies and private

agencies and organizations, including

institutions of higher education, Indian

tribes, and tribal organizations. This

program is designed to assist in the

development of solutions to the

problems encountered by individuals

with disabilities in their daily activities,

especially problems related to

employment (see 34 CFR 351.1). Under

the regulations for this program (see 34

CFR 351.32), the Secretary may

establish research priorities by reserving

funds to support the research activities

listed in 34 CFR 351.10.

Priorities

Under 34 CFR 75.105(c)(3), the

Secretary proposes to give an absolute

preference to applications that meet one

of the following priorities. The Secretary

proposes to fund under this program

only applications that meet one of these

absolute priorities:

Proposed Priority 1: Burn Injury

Rehabilitation Model System

Background

Each year more than 2.0 million

persons (about one percent of the

population of the United States) receive

a burn injury. Of these, 6,500 to 12,000

do not survive; 500,000 require medical

care and result in temporary disability

with respect to home, school, or work

activities; and 70,000 to 100,000 are

severe enough to be admitted to a

hospital (Rice, D.P. and MacKenzie, E.J.,

‘‘Cost of Injury in the United States: A

Report to Congress,’’ Atlanta, GA:

Centers for Disease Control, 1989).

In 1994, NIDRR provided funding to

establish Burn Injury Rehabilitation

Model Systems of Care. These R&D

projects focused primarily on

developing and demonstrating a

comprehensive, multidisciplinary

model system of rehabilitative services

for individuals with severe burns, and

evaluating the efficacy of that system

through the collection and analysis of

uniform data on system benefits, costs,

and outcomes. NIDRR’s multi-center

model systems program is designed to

study the course of recovery and

outcomes following the delivery of a

coordinated system of care including

emergency care, acute care management,

comprehensive in-patient rehabilitation,

and long-term interdisciplinary followup services.

Burn rehabilitation requires

interventions as soon as possible after

admission to hospitals and has

treatment implications for several years

following hospital discharge. Burn

trauma often causes injuries and

impairments in addition to the burn,

and many individuals with burn

injuries have secondary complications

related to the burn condition. These

may include open wounds,

contractures, neuropathies, cosmetic

abnormalities, deconditioning, bony

deformities, hypersensitivity to heat and

cold, amputation, psychosocial distress,

chronic pain, and scarring. The

complicated nature of burn injuries, the

difficulty of treatment, and the risk of

infection with possible loss of function

requires interventions quickly and

frequently to attempt to maintain a

functional lifestyle and return to living

independently. Minimization of

physical deterioration and prevention of

further impairment and functional

limitation is critical and research is

needed to find the appropriate

procedures for clinical applications.

Research is needed to develop and

refine methods to determine the

effectiveness of interventions to prevent,

manage, and reduce medical

complications that contribute to shortand long-term disability in burn

patients.

Improved measures are needed of an

individual’s functional ability as a result

of burn rehabilitation interventions.

Functional assessment brings objectivity

to rehabilitation by establishing

appropriate, uniform descriptors of

rehabilitation care and changes in

individual capacity to perform activities

of daily living or other measurable

elements of an individual’s major life

activities (Granger, C. and

Brownscheidle, C., ‘‘Outcome

Measurement in Medical

Rehabilitation,’’ International Journal of
Federal Register / Vol. 62, No. 42 / Tuesday, March 4, 1997 / Notices 9887

Technology Assessment in Health Care,

11:2, 1995). Increasingly, health and

rehabilitation services require

effectiveness and impact measures to

evaluate their services as a part of

procedures for cost-reimbursement and

billing for services. With greater

emphasis on individual choice in

services delivery, consumers and

advocates are likewise advocates for

functional assessment measures as

encoders of service effectiveness. Few

existing functional assessment

measures, however, address the

specialized and complex combination of

psychosocial and medical challenges

encountered by an individual who has

experienced severe burn injury (Rucker,

K., et al., ‘‘Analysis of Functional

Assessment Instruments for Disability

Rehabilitation Programs,’’ SSA Contract

No. 600–95–2194, Virginia

Commonwealth University, 1996).

Burn injuries can produce emotional

problems, such as post-traumatic stress

disorders, anxiety, and depression.

These problems may result from a

variety of causes (e.g., reaction to

cosmetic alterations, changes in

functional abilities, changes in work

status, restrictions on recreational

activities) (Cromes, G.F. and Helm, P.A.,

‘‘Burn Injuries,’’ in Medical Aspects of

Disability, pgs. 92–104, 1993). The

aesthetic disability of disfigurement is

frequently more severe than the

physical disability and may result in

profound social consequences for those

afflicted (Hurren, J.S., ‘‘Rehabilitation of

the Burned Patient: James Laing

Memorial Essay for 1993,’’ Burns, Vol.

21, No. 2, 1995). The more severe the

burn, the greater the likelihood of longterm psychosocial adjustment issues

related to both physical and

psychosocial problems, that affect

quality of life. Although psychosocial

adjustment is a critical factor in the

long-term recovery of burn injury

patients, there continues to be limited

emphasis on research in the area of

psychosocial rehabilitation and its

relationship to quality of life. Family

and friends play an important role and

provide major support in the

psychological recovery of burn patients.

Research in this area needs to address

the role of the family and personal

advocacy systems in providing support

during the burn injury rehabilitation

process.

Difficulty with long-term follow-up of

all patients after hospital discharge has

always been a problem, but it is even

more difficult when the individual lives

far from the specialized rehabilitation

unit. Problems are also encountered

with those individuals living in rural

areas, where access to burn injury

rehabilitation, including mental health

services, may be quite limited due to

lack of proximity to specialized

practitioners, limited access to

technological advances, and hospital

closures.

Return-to-work and educational

pursuits are important measures of

rehabilitation success. Work is an

important source of satisfaction, selfrespect, and dignity, as well as an arena

for socialization for individuals who

have experienced burn injury

(Salisbury, R., ‘‘Burn Rehabilitation: Our

Unanswered Challenge,’’ 1992

Presidential Address to the American

Burn Association, April, 1992).

However, the efficacy of vocational

rehabilitation interventions for this

population has not been documented

adequately. The physical, psychosocial,

and emotional factors that lead to

successful employment have not been

clearly identified. Research is needed to

examine relationships between

vocational interventions and supports,

employment, functional capacity, and

degree of burn injury, including

secondary complications.

Proposed Priority 1

The Secretary proposes to establish

Burn Injury Rehabilitation Model

Systems R&D projects for the purpose of

demonstrating a comprehensive,

multidisciplinary model system of

rehabilitative services for individuals

with severe burns. An R&D project

must:

(1) Identify and evaluate techniques to

prevent secondary complications;

(2) develop and evaluate outreach

programs to improve follow-up services

for rural populations;

(3) develop and evaluate measures of

functional outcome for burn

rehabilitation; and

(4) identify and evaluate

interventions, including vocational

rehabilitation interventions, to improve

psychosocial adjustment, quality of life,

community integration, and

employment-related outcomes.

In carrying out these purposes, the

R&D project must:

• Participate in clinical and systems

analysis studies of the burn injury

rehabilitation model system by

collecting and contributing data on

patient characteristics, diagnoses,

causes of injury, interventions,

outcomes, and costs to a uniform,

standardized national data base as

prescribed by the Secretary; and

• Consider collaborative projects with

other model systems.

Proposed Priority 2: Traumatic Brain

Injury Model Systems

Background

An estimated 1.9 million Americans

experience traumatic brain injury (TBI)

each year (Collins, J.F., ‘‘Types of

Injuries by Selected Characteristics: US

1985–87,’’ National Center for Health

Statistics, Vital Health Stat 10 (175),

1990). Incidence is highest among youth

and younger adults. Young males have

the highest incidence rates of any group

(‘‘Disability Statistics Abstract,’’ No. 14,

Disability Statistics Rehabilitation

Research & Training Center, University

of California, San Francisco, November,

1995). Each year approximately 70,000

to 90,000 TBI survivors enter a life of

continuing, debilitating loss of function;

an estimated 5,000 survivors experience

seizure disorders; and 2,000 enter into

a persistent vegetative state. The

number of people surviving head

injuries has increased significantly over

the last 25 years as a result of faster and

better emergency treatment, more rapid

and safer transport to specialized

treatment facilities, and advances in

medical treatment (National Foundation

for Brain Research, Washington, DC,

1994).

In 1987, NIDRR provided funding to

establish TBI Model Systems of Care.

These R&D projects focused primarily

on developing and demonstrating a

comprehensive, multidisciplinary

model system of rehabilitative services

for individuals with TBI, and evaluating

the efficacy of that system through the

collection and analysis of uniform data

on system benefits, costs, and outcomes.

NIDRR’s multi-center model systems

program is designed to study the course

of recovery and outcomes following the

delivery of a coordinated system of care

including emergency care, acute neurotrauma management, comprehensive inpatient rehabilitation, and long-term

interdisciplinary follow-up services.

The TBI Model Systems serve a

substantial number of patients, allowing

the projects to conduct clinical research

and program evaluation, which

maximize the potential for project

replication. In addition, the TBI Model

Systems have the advantage of a

complex data collection and retrieval

program with the capability to analyze

the different system components and

provide information on project cost

effectiveness and benefits. Information

is collected throughout the

rehabilitation process, permitting longterm follow-up on the course of injury,

outcomes, and changes in employment

status, community integration,

substance abuse and family needs. The

TBI Model Systems projects serve as
9888 Federal Register / Vol. 62, No. 42 / Tuesday, March 4, 1997 / Notices

regional and national models for

program development and as

information centers for consumers,

families, and professionals.

The TBI Model Systems National

Database reports that the average length

of stay in acute care has decreased

approximately 50 percent, from 30 days

in 1989 to 15 days in 1996; and the

average length of stay in in-patient

rehabilitation has decreased 38 percent,

from 52 days in 1989 to 32 days in 1996.

With the changing patterns of service

delivery, there continues to be a need to

establish and evaluate new

rehabilitation interventions and

strategies. Specialized measurement

tools have been developed by the TBI

Model Systems to assess progress and

describe clinical and functional

outcomes. Refinement of these

measurement tools is necessary to

demonstrate the effectiveness of

rehabilitation interventions in in-patient

and outpatient settings. After the

individual is discharged from an inpatient setting, there is an ongoing need

for outpatient and community

reintegration services in order to

continue therapeutic interventions and

the educational and referral process. As

the average length of stay in in-patient

settings decreases, there is a greater

need to evaluate outpatient and

community reintegration programs.

Findings from a multi-center

investigation of employment and

community integration following TBI

highlight the need for post-acute

rehabilitation programs with particular

emphasis on vocational rehabilitation

(Sander, A., et al., Journal of Head

Trauma Rehabilitation, Vol. 11, No. 5,

pgs. 70–84, 1996). Kreutzer states that

employment and productivity, relating

to others in the community, and

independently caring for oneself at

home are important quality-of-life

components (‘‘TBI: Models and Systems

of Care,’’ Conference Syllabus, Medical

College of Virginia, April, 1996). As

functional recovery progresses during

the first year or more after the injury,

the focus of rehabilitation shifts from

medical intervention and physical

restoration to psychosocial and

vocational adaptation. The ultimate goal

of psychosocial and vocational

rehabilitation is community

reintegration and employment. It is

important to emphasize that services

aimed at community reintegration must

consider not only attributes and

limitations of the injured individuals,

but also the social, educational, and

vocational systems in which the

individual will function. In addition,

rates of competitive employment

decrease substantially from pre-injury

levels. Head injury frequently results in

unemployment, and there are significant

relationships between risk factors (e.g.,

substance abuse) and this changed

employment status. However, there is

no reliable information regarding the

magnitude of risk associated with

different factors, or with different levels

of these factors (Dikmen, S., et al.,

‘‘Employment following Traumatic

Head Injuries,’’ Archives of Neurology,

Vol. 51, February, 1994).

A major disability like TBI has a

profoundly disorganizing impact on the

lives of individuals with TBI and their

families. Questions involving

community, family, and vocational

restoration, as well as generic concerns

about future happiness and fulfillment,

are common (Banja, J., & Johnston, M.,

‘‘Ethical Perspectives and Social

Policy,’’ Archives of Physical Medicine

Rehabilitation, Vol. 75, SC–19,

December, 1994). Even individuals who

have integrated well into society

experience adverse psychosocial effects.

Employment instability, isolation from

friends, and increased need for support

are a few of the problems encountered

by individuals with TBI. Families often

function as the primary support system

for individuals with TBI after they are

discharged. There is a clear need for

research to develop family treatment

strategies and explore their effect on

outcomes for individuals with TBI.

The health care costs associated with

TBI are staggering. The direct medical

costs of TBI treatment have been

estimated at more than $4 billion

annually (Max, W., et al., ‘‘Head

Injuries: Costs and Consequences,’’

Journal of Head Trauma Rehabilitation,

Vol. 6, pgs. 76–91, 1991). In view of

current scrutiny of all health care

spending, which may result in pressures

to constrict or deny rehabilitation care

to individuals with traumatic brain

injury, it is important to gather

information on the efficacy and costeffectiveness of various treatment

interventions and service delivery

models. Credible outcome monitoring

systems are needed to establish

guidelines by which fair compromises

can be reached (Johnston, M. & Hall, K.,

‘‘Outcomes Evaluation in TBI

Rehabilitation, Part I: Overview and

System Principles,’’ Archives of

Physical Medicine and Rehabilitation,

Vol. 75, December, 1994). A greater

emphasis on outcomes measurements

and management will foster the

gathering of information on efficacy and

cost-effectiveness.

Violence-induced TBI is increasingly

common, and has significant

implications for rehabilitation and

community reintegration. According to

the 1991 National Health Interview

Survey data, violence was responsible

for nine percent of all non-fatal TBIs. In

addition, violence was a cause of injury

in 30 percent of the 684 external injury

cases in the TBI Model Systems

database (a higher frequency due, in

part, to the urban setting of one of the

TBI Model Systems). The frequency of

violence as a cause of TBI, in part, can

be attributed to the fact that the

individuals most likely to sustain TBI

(i.e., males under age 18) are also those

most likely to be involved in crimes and

violence. The increase in violence as a

cause of brain injury may have

consequences with regard to

rehabilitation costs, treatment

interventions and long-term outcomes.

For example, individuals with violencerelated injuries show more difficulties

with community integration skills one

year following injury, which evidences

itself in areas of social integration and

productivity. Further research is needed

to examine whether individuals who

sustain a TBI as a result of violence

require specialized rehabilitation

interventions.

Proposed Priority 2

The Secretary proposes to establish

Model Systems TBI R&D projects for the

purpose of demonstrating a

comprehensive, multidisciplinary

model system of care for individuals

with TBI. An R&D project must:

(1) Investigate efficacy of alternative

methods of service delivery

interventions after in-patient

rehabilitation discharge;

(2) Identify and evaluate interventions

that can improve vocational outcomes

and community integration;

(3) Develop key predictors of

rehabilitation outcome at hospital

discharge and at long-term follow-up;

(4) Determine relationships between

cost of care and functional outcomes;

and

(5) Examine the implications of

violence as a cause of TBI on treatment

interventions, rehabilitation costs, and

long-term outcomes.

In carrying out these purposes, the

R&D Systems project must:

• Participate in clinical and systems

analysis studies of the traumatic brain

injury model system by collecting and

contributing data on patient

characteristics, diagnoses, causes of

injury, interventions, outcomes, and

costs to a uniform, standardized

national data base as prescribed by the

Secretary;

• Consider collaborative projects with

other model systems; and
Federal Register / Vol. 62, No. 42 / Tuesday, March 4, 1997 / Notices 9889

• Coordinate research efforts with

other NIDRR grantees that address TBIrelated issues.

Rehabilitation Research and Training

Centers (RRTCs)

Authority for the RRTC program of

NIDRR is contained in section 204(b)(2)

of the Rehabilitation Act of l973, as

amended (29 U.S.C. 760–762). Under

this program the Secretary makes

awards to public and private

organizations, including institutions of

higher education and Indian tribes or

tribal organizations for coordinated

research and training activities. These

entities must be of sufficient size, scope,

and quality to effectively carry out the

activities of the Center in an efficient

manner consistent with appropriate

State and Federal laws. They must

demonstrate the ability to carry out the

training activities either directly or

through another entity that can provide

such training.

The Secretary may make awards for

up to 60 months through grants or

cooperative agreements. The purpose of

the awards is for planning and

conducting research, training,

demonstrations, and related activities

leading to the development of methods,

procedures, and devices that will

benefit individuals with disabilities,

especially those with the most severe

disabilities.

Under the regulations for this program

(see 34 CFR 352.32) the Secretary may

establish research priorities by reserving

funds to support particular research

activities.

Description of the Rehabilitation

Research and Training Center Program

RRTCs are operated in collaboration

with institutions of higher education or

providers of rehabilitation services or

other appropriate services. RRTCs serve

as centers of national excellence and

national or regional resources for

providers and individuals with

disabilities and the parents, family

members, guardians, advocates or

authorized representatives of the

individuals.

RRTCs conduct coordinated and

advanced programs of research in

rehabilitation targeted toward the

production of new knowledge to

improve rehabilitation methodology and

service delivery systems, to alleviate or

stabilize disabling conditions, and to

promote maximum social and economic

independence of individuals with

disabilities.

RRTCs provide training, including

graduate, pre-service, and in-service

training, to assist individuals to more

effectively provide rehabilitation

services. They also provide training

including graduate, pre-service, and inservice training, for rehabilitation

research personnel and other

rehabilitation personnel.

RRTCs serve as informational and

technical assistance resources to

providers, individuals with disabilities,

and the parents, family members,

guardians, advocates, or authorized

representatives of these individuals

through conferences, workshops, public

education programs, in-service training

programs and similar activities.

NIDRR encourages all Centers to

involve individuals with disabilities

and minorities as recipients in research

training, as well as clinical training.

Applicants have considerable latitude

in proposing the specific research and

related projects they will undertake to

achieve the designated outcomes;

however, the regulatory selection

criteria for the program (34 CFR 352.31)

state that the Secretary reviews the

extent to which applicants justify their

choice of research projects in terms of

the relevance to the priority and to the

needs of individuals with disabilities.

The Secretary also reviews the extent to

which applicants present a scientific

methodology that includes reasonable

hypotheses, methods of data collection

and analysis, and a means to evaluate

the extent to which project objectives

have been achieved.

The Department is particularly

interested in ensuring that the

expenditure of public funds is justified

by the execution of intended activities

and the advancement of knowledge and,

thus, has built this accountability into

the selection criteria. Not later than

three years after the establishment of

any RRTC, NIDRR will conduct one or

more reviews of the activities and

achievements of the Center. In

accordance with the provisions of 34

CFR 75.253(a), continued funding

depends at all times on satisfactory

performance and accomplishment.

General

The Secretary proposes that the

following requirements will apply to

these RRTCs pursuant to the priorities

unless noted otherwise:

Each RRTC must conduct an

integrated program of research to

develop solutions to problems

confronted by individuals with

disabilities.

Each RRTC must conduct a

coordinated and advanced program of

training in rehabilitation research,

including training in research

methodology and applied research

experience, that will contribute to the

number of qualified researchers working

in the area of rehabilitation research.

Each Center must disseminate and

encourage the use of new rehabilitation

knowledge. They must publish all

materials for dissemination or training

in alternate formats to make them

accessible to individuals with a range of

disabling conditions.

Each RRTC must involve individuals

with disabilities and, if appropriate,

their family members, as well as

rehabilitation service providers, in

planning and implementing the research

and training programs, in interpreting

and disseminating the research findings,

and in evaluating the Center.

Priorities

Under 34 CFR 75.105(c)(3), the

Secretary proposes to give an absolute

preference to applications that meet one

of the following priorities. The Secretary

proposes to fund under these

competitions only applications that

meet one of these absolute priorities:

Proposed Priority 3: Effective

Interventions for Children and Youth

With Disabilities Who Exhibit Severe

Problem Behaviors

Background

In recent years researchers have

focused on the application of nonaversive approaches to reduce and

eliminate severe problem behaviors

(SPBs) exhibited by children and youth

with disabilities. This has been the case

because of ethical concerns about

aversive interventions expressed by

disability professionals, parents, and

advocates, as well as research findings

which indicate that aversive

interventions are largely ineffective in

eliminating or reducing SPBs over an

extended period of time. Because of

their disruptive nature, SPBs such as

physical aggression, self-injury,

violence, and property destruction are

among the primary obstacles to full

inclusion of children and youth with

disabilities in age-appropriate

community-based activities and regular

education settings. School and

community-based program personnel

need effective methods to reduce and

eliminate SPBs in order to provide these

children and youth with disabilities

with opportunities to learn, play, and

work with their non-disabled peers.

Previous research in this area has

improved our understanding of the early

indicators of SPBs. For example,

children with disabilities who display

minor self-injurious behavior during the

preschool years are strong candidates to

exhibit more SPBs within two years

(Hall, S., ‘‘Early Intervention of Self-
9890 Federal Register / Vol. 62, No. 42 / Tuesday, March 4, 1997 / Notices

injurious Behavior in Young Children

with Intellectual Disabilities:

Naturalistic Observation,’’ Presented at

the Annual Meeting of the American

Association of Mental Retardation, San

Francisco, June, 1995). Further research

is needed on how severe problem

behavior patterns develop and whether

early intervention efforts can reduce,

and perhaps prevent, SPBs.

Preliminary research has also

indicated that problem behaviors can be

reduced by understanding the

antecedents to and function of the

behavior. Accordingly, children and

youth with disabilities who exhibit

SPBs may be able to learn to selfmanage their problem behaviors.

While there are encouraging

indications that non-aversive

approaches can be effective in reducing

and eliminating SPBs, there is a need to

develop effective interventions that can

be maintained over extended periods of

time. Treatments of self-injurious

behaviors are particularly problematic

in regard to long-term effectiveness.

Research has shown that children who

exhibit self-injurious behaviors, even

after intensive non-aversive treatment

programs, may revert to self-injury at

high rates within a few months of

intervention (Durand, V.M., et al., ‘‘The

Course of Self-injurious Behavior

Among People with Autism,’’ Paper

presented at the Annual Meeting of the

Berkshire Association for Behavior

Analysis and Therapy, Amherst, MA.

1995).

Information from functional

assessments can be used to develop

educational plans and address

inappropriate behavior. Functional

assessment is the general label assigned

to describe a set of processes (e.g.,

interviews, rating, rating scales, direct

observations, and systematic

experimental analyses of specific

situations) for defining the events in an

environment that reliably predict and

maintain behaviors. More research

needs to be been done in order to

expand the application of functional

assessments with children and youth

with disabilities who exhibit severe

behavior problems.

Under normal circumstances,

children and youth with disabilities

who exhibit SPBs in school and the

community are also exhibiting these

behaviors at home. In order for nonaversive approaches to be implemented

consistently across environments,

parents and other caregivers must not

only consent to the approach, but also

be capable of implementing the

approach effectively in the home

environment. The non-aversive

strategies that are developed must be

compatible with the home environment,

and take into account providing parents

and guardians with the skills they need

to implement the program effectively.

Proposed Priority 3

The Secretary proposes to establish an

RRTC for the purpose of providing

school and community-based program

personnel with effective methods to

reduce and eliminate SPBs in children

and youth with disabilities. The RRTC

shall:

(1) Develop and evaluate non-aversive

interventions that reduce and eliminate

severe behavior problems exhibited by

children and youth with disabilities;

(2) Investigate the etiology of SPBs for

the purpose of developing prevention

and early intervention strategies;

(3) Investigate the durability and

maintenance of effective non-aversive

interventions;

(4) Investigate the effectiveness of

self-management strategies;

(5) Develop and evaluate functional

assessments to address SPBs in

educational and community-based

settings;

(6) Develop materials and provide

training to educators, community-based

program personnel, parents, and

caregivers who address SPBs; and

(7) Develop and disseminate

informational materials and provide

technical assistance to local and State

educational agencies to address SPBs.

In carrying out the purposes of the

priority, the RRTC shall disseminate

materials and coordinate training

activities with related projects

supported by the Office of Special

Education Programs, including the

Regional Resource Centers and Parent

Information Centers.

Proposed Priority 4: Aging With Spinal

Cord Injury

Background

Persons who experience a spinal cord

injury (SCI) and related conditions are

surviving in significant numbers to late

middle age and beyond. Less than fifty

years ago the average life expectancy for

a spinal cord injured individual in the

United States was approximately three

years post-injury; today life expectancy

approaches that of the general

population (Enders, A., ‘‘Issues and

Options in Technology for Disability

and Aging,’’ National Conference on

Disability and Aging, Institute for

Health and Aging, San Francisco, 1986).

Estimates of spinal cord injury

prevalence in America range from

180,000 to 250,000 with between 7,000

and 10,000 new spinal cord injuries

each year (National Spinal Cord Injury

Statistical Center, The University of

Alabama at Birmingham, 1995). One of

four individuals who previously

sustained a spinal cord injury is now at

least 20 years post-onset. The average

age of a SCI survivor is now about 48

years and about 20 percent of SCI

survivors are over age 60.

Many SCI survivors develop new

medical, functional, and psychological

problems that threaten their

independence. In addition, many

experience job loss, barriers to accessing

proper health maintenance and

caregiver/personal assistance services,

loss of financial assistance, and

economic hardship. Persons aging with

SCI are susceptible to multiple health

maintenance problems including

cardiovascular, urinary tract infections,

pressure sores, hypertension, fractures,

blood in the urine or bowel problems,

diabetes, respiratory and neurological

problems (Whiteneck, G. (Ed.), Aging

with a Spinal Cord Injury, 1992). The

leading medical cause of death and

further disability that affects people

with SCI is now premature

cardiovascular disease of the

atherosclerotic kind. Whiteneck, using

data from England, found that

cardiovascular disease is now tied with

genito-urinary problems as the leading

cause of death in people aging with SCI.

Individuals aging with a SCI also

experience complications as a result of

osteoporosis and lower extremity

fractures (Garland, D.E., ‘‘Bone Mineral

Density about the Knee in SCI Patients

with Pathological Fractures,’’

Contemporary Orthopaedics, 1992 and

Garland, D.E., ‘‘Osteoporosis Following

SCI,’’ Journal of Orthopaedic Research,

1992). Garland discovered a high

prevalence of carpal tunnel syndrome,

which increased with the length of time

after injury. In addition, Sie found an

increased prevalence of general upper

extremity pain and shoulder pain with

time since injury in both paraplegic and

tetraplegia individuals (Sie, I., ‘‘Upper

Extremity Pain in the PostRehabilitation SCI Injured Patient,’’

Archives of Physical Medicine and

Rehabilitation, 1992). Shoulder pain

occurs in about 50 percent of people

with paraplegia secondary to prolonged

wheelchair use. Pain, fatigue and

weakness are also commonly reported

but accommodations for them are poorly

understood.

Further research is needed to

determine the changes in functional

ability to perform activities of daily

living (ADL) and work. Research related

to work performance and employment

status indicates that ten years after the

SCI, the employment rate peaks at about

40 percent for persons with paraplegia
Federal Register / Vol. 62, No. 42 / Tuesday, March 4, 1997 / Notices 9891

and at 28 percent for persons with

quadriplegia, and sharply declines

about 18 years after the post-injury (SCI

Model Systems Annual Report, 1992).

Interventions are needed to maintain the

employment status of people aging with

SCI and prevent job loss due to

premature aging effects.

As people age and their functioning

changes, the need for assistance from

others (i.e., family, friends, and paid

caregivers) increases. Strategies to best

assist the caregiver, in turn, to help the

person who is aging with SCI need to be

developed. Moreover, there is no

‘‘typical’’ caregiver, some are spouses,

some are parents, and some are

children. Fifty percent of people with

SCI receive help exclusively from their

families, and an additional 19 percent

receive substantial help from their

families. Living with family is the most

frequently reported living situation,

occurring in over 90 percent of cases

(Nosek, M.A., ‘‘Personal Assistance: Key

to Maintaining Ability of Persons with

Physical Disabilities,’’ Applied

Rehabilitation Counselor, Vol. 21,

1990).

Declining or unstable support systems

for people aging with SCI are also a

major concern. Since parents of aging

SCI individuals are often elderly, they

are also at risk of poor health or death.

Spousal support providers may

experience ‘‘burn-out’’ and stress, or

develop health problems. There are few

alternatives to the informal support

system. As individuals with SCI age,

access to proper health care, especially

with the growing trend toward managed

care, is becoming a bigger problem.

There is need for research on

maintaining independence in the

community for people aging with SCI

through both the informal and formal

systems of care.

Psychological well-being for

individuals aging with SCI is also of

major concern. Depression is a very

important issue requiring additional

study because of its bearing on quality

of life, its importance for overall health,

and its relationship to suicide (Schulz,

R., ‘‘Long Term Adjustment to Physical

Disability: The Role of Social Support

Service of Control and Self Blame,’’

Journal of Personality and Social

Psychology, 5, pgs. 1162–1172, 1985).

The research indicates that over 40

percent of people who have sustained

functional changes as a consequence of

aging with SCI show high levels of

distress and depression. Pilot data on

treatment are available from the NIDRRfunded centers, but a full treatment

procedure for stress and depression

needs to be developed.

Proposed Priority 4

The Secretary proposes to establish an

RRTC for the purpose of conducting

research on rehabilitation techniques

that assist individuals aging with SCI to

maintain employment and

independence in the community. The

RRTC shall:

(1) Identify, develop, and evaluate

interventions that maintain employment

for individuals aging with SCI;

(2) Identify, develop, and evaluate

rehabilitation techniques that will assist

individuals aging with SCI to cope with

changes in functional abilities, changes

in ADL, and the impact of these

techniques on quality of life;

(3) Investigate how formal and

informal systems of care could be

improved to address the impact of

problems associated with long-term care

givers and personal service assistants;

(4) Develop a program of information

dissemination and training for

individuals aging with SCI and those

who provide services to them;

(5) Develop regimens to minimize or

take account of the impacts of aging

with SCI and develop materials that

support these regimens for individuals

with SCI, their families, service

providers and educators; and

(6) Develop materials for individuals

with SCI, their families, service

providers and educators that will

provide a better understanding of the

natural course of SCI as persons age.

In carrying out the purposes of the

priority, the RRTC shall coordinate with

all other relevant SCI research and

demonstration activities, including

those sponsored by the National Center

on Medical Rehabilitation Research,

RSA, Paralyzed Veterans of America,

National Spinal Cord Injury Association

and NIDRR-funded SCI projects.

Knowledge Dissemination and

Utilization Projects

Authority for the D&U program of

NIDRR is contained in sections 202 and

204(a) of the Rehabilitation Act of 1973,

as amended (29 U.S.C. 760–762). Under

this program the Secretary makes

awards to public and private

organizations, including institutions of

higher education and Indian tribes or

tribal organizations. Under the

regulations for this program (see 34 CFR

355.32), the Secretary may establish

research priorities by reserving funds to

support particular research activities.

Priority

Under 34 CFR 75.105(c)(3), the

Secretary proposes to give an absolute

preference to applications that meet the

following priority. The Secretary

proposes to fund under this competition

only applications that meet this absolute

priority:

Proposed Priority 5: Improving the

Utilization of Existing and Emerging

Rehabilitation Technology in the State

Vocational Rehabilitation Program

Background

One of the more persistent issues in

the rehabilitation of individuals with

disabilities has been maximizing the use

of existing and emerging rehabilitation

technology in the service settings of the

State Vocational Rehabilitation (VR)

programs.

As defined in Section 7(13) of the

Rehabilitation Act, as amended (Act),

rehabilitation technology means ‘‘the

systematic application of technologies,

engineering methodologies, or scientific

principles to meet the needs of and

address the barriers confronted by

individuals with disabilities in areas

which include education, rehabilitation,

employment, transportation,

independent living and recreation’’ and

includes ‘‘rehabilitation engineering,

assistive technology devices, and

assistive technology services.’’ Under

Section 101(a)(5)(C) of the Act,

designated VR agencies must describe in

their State plan how the State will

provide a broad range of rehabilitation

technology services at each stage of the

rehabilitation process. As appropriate,

rehabilitation technology services are

provided to individuals with disabilities

served by State VR programs under an

Individualized Written Rehabilitation

Program.

Rehabilitation technology, and

information about rehabilitation

technology, is generated by a variety of

sources including, but not limited to,

NIDRR-funded Rehabilitation

Engineering and Research Centers, the

Assistive Technology program funded

under the Technology-Related

Assistance for Individuals with

Disabilities Act of 1988, ABLEDATA,

the Department of Veterans Affairs

Research and Development projects, and

manufacturers in the private sector.

While many of these sources may

undertake dissemination activities, too

often rehabilitation counselors and

related vocational rehabilitation service

providers are unaware of existing or

emerging rehabilitation technologies,

resulting in a number of problems for

clients of the State vocational

rehabilitation system.

The provision of inappropriate

rehabilitation technology can result in

nonuse. The nonuse of a device may

lead to decreases in functional abilities,

freedom, and independence. On a
9892 Federal Register / Vol. 62, No. 42 / Tuesday, March 4, 1997 / Notices

service delivery level, device

abandonment represents ineffective use

of limited funds by Federal, State, and

local government agencies, insurers, and

other provider organizations (Phillips,

B. and Hongxin, Z., ‘‘Predictors of

Assistive Technology Abandonment,’’

Assistive Technology, Vol. 5, No. 1, pg.

36, 1993).

If vocational rehabilitation personnel

are unfamiliar with an emerging

technology, their clients are

disadvantaged by not having access to

recent developments in the field. These

developments may be more effective

and economical than existing

rehabilitation technology. Because of

the costs that can be involved, the

decision to utilize a particular

rehabilitation technology, even if the

technology is outdated, can be difficult

to reverse or modify.

Information barriers related to

rehabilitation technology also apply to

secondary students with disabilities

who increasingly complete their

education with the help of assistive

devices (Everson, J., ‘‘Using Personcentered Planning Concepts to Enhance

School-to-Adult Life Transition

Planning,’’ Journal of Vocational

Rehabilitation, Vol. 6, 1996). In order to

ensure their continued access to

technical accommodation as part of

their transition to employment and

independent living, special education

and vocational rehabilitation personnel

involved in their transition must have

proper training and access to current

information.

Assigning inappropriate or outdated

rehabilitation technology to consumers

can be avoided if vocational

rehabilitation personnel are provided

with comprehensive and current

information on existing and emerging

rehabilitation technology. Rehabilitation

counselors and related vocational

rehabilitation service providers gain

access to information about

rehabilitation technology from various

sources including, but not limited to,

their pre-service and in-service training,

memberships in professional

organizations, conferences, and more

recently through the information

superhighway. Because the field of

rehabilitation technology is developing

rapidly, and because it is a technically

diverse and complex field, it has been

a challenge for rehabilitation personnel

development programs to keep pace

with rehabilitation technology. There is

a growing need for dissemination of

information about rehabilitation

technology, including the development

of pre-service and in-service resources,

in order to promote improved

rehabilitation professional training on

rehabilitation technology.

Proposed Priority 5

The Secretary proposes to establish a

knowledge dissemination and

utilization project for the purpose of

improving the ability of rehabilitation

professionals to more effectively use

rehabilitation technology in providing

services to individuals through the State

VR Services program. The proposed

D&U project must:

(1) evaluate the pre-service and inservice rehabilitation professional

training materials that address

rehabilitation technology and identify

strengths and deficiencies in those

materials;

(2) Based on this evaluation, develop

training materials that will improve the

ability of rehabilitation counselors and

related professionals to utilize existing

and emerging rehabilitation technology;

(3) Disseminate these materials to preservice and in-service rehabilitation

professional training programs;

(4) As needed, provide technical

assistance to these pre-service and inservice training programs to maximize

the use of the materials; and

(5) Using a variety of strategies,

disseminate information about existing

and emerging rehabilitation technology

to rehabilitation counselors, special

educators involved with the transition

of secondary students, and related

rehabilitation professionals.

In carrying out the purposes of the

priority, the proposed D&U project

must:

• Coordinate with the Assistive

Technology projects to avoid

duplication of effort;

• Develop information about existing

and emerging rehabilitation technology

from a wide variety of sources; and

• On a regular basis, update the

information and materials that are

developed.

Invitation To Comment

Interested persons are invited to

submit comments and recommendations

regarding these proposed priorities.

All comments submitted in response

to this notice will be available for public

inspection, during and after the

comment period, in Room 3423, Mary

Switzer Building, 330 C Street S.W.,

Washington, D.C., between the hours of

8:00 a.m. and 3:30 p.m., Monday

through Friday of each week except

Federal holidays. APPLICABLE

PROGRAM REGULATIONS: 34 CFR

Parts 350, 351, and 352.

Program Authority: 29 U.S.C. 760–762.

Dated: February 27, 1997.

(Catalog of Federal Domestic Assistance

Numbers: 84.133A, Research and

Demonstration Projects, 84.133B,

Rehabilitation Research and Training Center

Program, 84.133D, Knowledge Dissemination

and Utilization Program)

Judith E. Heumann,

Assistant Secretary for Special Education and

Rehabilitative Services.

[FR Doc. 97–5241 Filed 3–3–97; 8:45 am]

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